05.Depression in Australia
It's been said that in any one month 4% of Australians are suffering from depression, and one in five will suffer depression in their lifetime. It's estimated to cost the community $3 billion per year in direct and indirect costs.
Rates of reported depression are on the increase, partly because people are becoming increasingly aware of depression symptoms and coming forward for treatment rather than suffering alone, but also because we (the human race) seem to be getting more and more depressed.
Yet there's concern that despite a big increase in reported levels of depression, it's still underdiagnosed, and it's predicted that it will be the second-largest burden of disease in Australia by the year 2020. Already it's the second most common chronic problem for which people visit a GP, with GPs prescribing around 80-90% of all antidepressants.
What is 'mild' depression?
The official definition of mild depression is having suffered at least two weeks of abnormal sadness or low mood, and being less interested in doing things you previously enjoyed, as well as at least one of the following symptoms: loss of confidence, feelings of excessive guilt, thoughts of death, poor concentration, agitation or retardation (mental and physical slowness), sleep disturbances or change in appetite.
Unlike with more severe forms of depression, people with mild depression can still continue to function at work and home and take part in social activities, but not as well as usual and with less motivation.
Mild depression is usually under-reported because people don't think the symptoms are bad enough to get help, which is unfortunate because diagnosing and treating depression at this early stage can help prevent it becoming worse.
Are we overmedicating?
The use of antidepressants in Australia rose by about 17% per year over the 10 years to 2001, reflecting a worldwide trend. Dramatic increases in depressed patients are bound to put a strain on human medical resources, and prescribing drugs is a time- and cost-effective way of dealing with those who seek treatment. Aggressive marketing by the drug companies may also have increased prescription rates.
But it's not always a good solution. For a start, there's not a lot of evidence the drugs are effective for people with mild depression, although they can be for some. It also reinforces the 'pill for every ill' mentality. Some experts are concerned that prescribing drugs may simply mask psycho-social problems that could be dealt with more effectively by counselling or talking therapies, like cognitive behaviour therapy (CBT). Curing the symptoms won't necessarily cure the illness or provide a long-term solution.
Dependence and withdrawal symptoms are also not unknown, meaning some people are using drugs for long periods of time. And there are many concerns about long-term effects and side effects of newer antidepressants, and even doubts as to how well they work. It's increasingly being recommended that drugs aren't prescribed as a first-line treatment of mild depression.
The preferred treatment for people with mild depression is often counselling or psychological therapy, such as CBT, and many do receive this treatment. Some GPs have been undergoing special training for managing depression, including treatment using focused psychological therapies. Other non-drug management strategies – exercise and 'bibliotherapy' (relevant self-help books) – have also been found useful.
The internet can also be a useful source of treatment, and a study looking at two Australian National University sites – BluePages (designed to educate people about depression) and MoodGym (an interactive website offering information about CBT) – found that they were helpful at reducing symptoms of depression.
The Royal Australian College of General Practitioners recommends the following websites about depression:
www.reachout.com.au (aimed particularly at youth)