What many people are unaware of is that depression can be a progressive disorder that gets worse as time goes on. Not only does the person experience more severe symptoms over time, but the brain becomes sensitized and is more and more easily triggered into a depressive episode. Whereas early episodes might occur in response to a major stress or loss, later episodes may appear to come on out of the blue.
Over time depression also becomes more difficult to treat. Later episodes often require a longer period on medication before the individual responds with a full remission of symptoms.
Failing to effectively treat depression often leads to a long-term inability to hold employment with many more disability days than average. I often see patients who have been unable to work for several years as a result of their depression, but who have never received adequate treatment.
Inability to work can lead to a lower standard of living among untreated depressed individuals as well as less satisfaction with life, chronically low self-esteem and the break-up of relationships and families. Other critical problems that accompany untreated depression include a higher risk of developing a substance abuse problem as well as a higher risk of suicide.
Media coverage of depression tends to focus on ‘good news’ stories: new antidepressants that are rapidly effective with few side-effects, cognitive therapy that can work without medication, life-style changes and stress management techniques that help prevent depression. Often, these stories and techniques are useful and represent breakthroughs in treatment.
Unfortunately, major depression is most often a recurrent problem with episodes becoming more frequent and more severe over a life time. One study found that only about 20 per cent of hospitalized depressed patients had remained continuously well at a 15-year follow-up. Seven per cent had committed suicide, and 12 per cent had remained incapacitated by their illness. The rest had experienced recurrences or remained symptomatic.
Another study that followed patients receiving specialist care for depression found most patients were symptomatic in 59 per cent of weeks after 12 years. In 15 per cent of weeks, most patients met full criteria for major depression.
All of this does not mean that those suffering from untreated depression will never recover. Seeking treatment at any point in life usually leads to marked improvement in symptoms and quality of life. Many times, the patients I see who have been out of work and chronically depressed are able to return to normal daily activities once they receive appropriate treatment.
It does mean that if you are depressed you should not procrastinate and you should not settle for partial treatment. The goal is total remission of symptoms as fast as possible. Worries about the cost, inconvenience or side-effects of treatment have to be balanced against the possibly devastating effects of doing nothing.
Early intervention is important in many other psychiatric conditions as well. Schizophrenia, anxiety disorders and other mood conditions such as bipolar disorder are just a few examples of chronic psychiatric conditions that benefit from early intervention.
If you think you or someone you love is experiencing depression or another psychiatric illness, speak with your family doctor about it. The sooner you get help, the better.
Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.
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