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There are an enormous variety of reasons why people get depressed, some which
are identified in the following list:
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Comorbid conditions of personality disorder, anxiety
disorders or substance abuse increase the risk of depression.
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Depression results from a complex interplay between
genetic liability and environmental factors.
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Depression is often linked to life changing events.
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Childhood adversity (neglect and abuse experiences) is a
risk factor for major depression.
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Stress.
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Urbanisation is associated with increased stressors and
adverse life events.
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Rurality may be associated with increased isolation and
limited facilities.
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Postnatal depression affects approximately 10% women.
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Sexuality variations increase the risk of depression
because of prejudice and stigma.
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Social factors may increase the risk of depression:
|
Chronic Disease |
Risk of Major Depression |
| Diabetes |
11-15% |
| Recent Myocardial Infarction |
15-23% |
| Coronary Artery Disease |
15-23% |
| Post-Stroke (at 3-4 months) |
9-31% |
| Parkinson's Disease |
50% |
| Multiple Sclerosis |
16-30% |
| HIV |
10% |
| Rheumatoid Arthritis |
20% |
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Depressive disorder is a common, complex and debilitating
condition with potentially fatal consequences (Montgomery, 1995; Manning,
2003).
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Depression affects one in five people at some point in their lives (Depression
Alliance, 2006).
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Depression is frequently inadequately recognised and
ineffectively treated and leads to disability equivalent to that of chronic
medical conditions (Paykel, 1992).
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Depression is predicted to be the
highest-ranking cause of disease burden in developed countries by 2020 (WHO, 2001).
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Depression places a significant burden
on the individual, their family, the NHS and the economy.
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The total cost of
depression in people aged over 15 years in England in 2000 is estimated to be in
excess of £9billion (Thomas, 2003).
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Approximately
10% of patients who consult their GP meet
the criteria for mild or moderate depression (DTB, 2003).
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The National Service
Framework (NSF) for Mental Health (DoH, 1999a) stated that 25% of routine GP
consultations are for people with a mental health problem; the latest
estimate is 30% of consultations are for people with mental health problems
(MHF, 2005).
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Mild to moderate
depression is managed almost entirely within primary care and although the
majority of patients’ symptoms resolve within 6-12 months, approximately 20% of
patients have symptoms which persist, becoming chronic and disabling.
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The World Health
Organisation (WHO) has identified chronic relapsing depression as one of the four most disabling illnesses in the world (Murray, 1997).
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Depression is a personal and complex illness
experience.
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It is important for healthcare professionals to understand the
different aspects of the patient experience relating to antidepressant
medication; the beginning of medication, adherence to the medication
regimen, and stopping treatment when appropriate.
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Involving patients with
depression in research about depression will help to identify the important questions
and is more likely to produce results that can be implemented and
disseminated within the wider healthcare arena.
The benefit of exercise to physical health is well-known, but the benefits to
mental health are less well-known. A study undertaken by The Mental Health
Foundation (MHF, 2005) shows that a supervised programme of exercise is as
effective as antidepressants in treating mild or moderate depression. This
provides good evidence for promoting exercise as a first-line treatment.
Alongside this, exercise has few negative side effects and has a number of
associated benefits:
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It can be used to treat patients who have both mental and physical
health problems.
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It is associated with reduced anxiety, decreased depression, enhanced
mood, improved self-worth and body image, and improved cognitive
functioning.
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It is a sustainable recovery choice.
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It promotes social inclusion.
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It is a popular treatment.
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It is a normalising treatment.
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It is less expensive than antidepressant medication.
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It is an effective prophylactic against depression.
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It is patients (service users) who
identify the issues which are important to them and help researchers
identify the important research questions (Hanley, 2000).
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Patients often provide different
views which result in innovative and imaginative solutions unthought of by
healthcare professionals (DoH, 1999b).
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The systematic review by
Crawford et al of involving patients in the planning
and development of services confirms that service users do contribute to
changes in service provision (Crawford, 2002).
My current
research into the fears and concerns of patients about stopping antidepressant
medication is a research question identified by patients in the earlier research
I undertook as part of an MSc.
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The clinical problem for the
healthcare professional
is to know how to respond to patient fears about stopping antidepressant
medication in order to avoid long-term use of expensive medications in patients
who may no longer need them.
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A knowledge of this fear, an understanding of what
it is the patient dreads, and an understanding of what model of recovery the
patient has, if indeed they actually have a model of recovery, will facilitate
the development of an appropriate counselling strategy(s) for use by healthcare
professionals in primary care.
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These are important aspects in depression
which require their own evidence base.
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