Last year, like many of you here in Jasper, I lost a friend, Jeanine, to depression. The journey since has been a tough one: grief, guilt, and worry for friends for which the loss has triggered their own depression and mental health issues.
In some ways, I am beginning to make my peace. I’ve had some experience with the death of friends, and at the very least have come to understand that death doesn’t discriminate by age, and rarely is fair.
Still, I find myself regularly seduced by the desire to make some sense of it—to have an inkling of anything I could do to make things better for people with this disease. I’ve been trying to learn as much as I can from a scientific perspective, and the journey has been anything but straight-forward.
To help clear things up, at least from a psychiatric perspective, I spoke with Dr. Scott Patten, a Professor at the University of Calgary’s departments of Community Health Sciences and Psychiatry. Patten studies the patterns, causes and effects of major depression.
What is depression?
This should be an easy one, and yet looking for an answer to this question can be as fraught with complexity as the disease itself, and a bit of a rabbit hole as its definition varies from source to source.
“Depression is a word that means different things to different people,” said Patten.
Part of the difficulty in defining and understanding depression and its causes is that it unfolds across a spectrum, he said.
“It could be something fairly mild and self-limited, or it could be something that contributes to [a person’s death], or is incredibly disabling.”
He gave the example of a person who becomes depressed after the death of a loved one. “That’s not only normal, but probably healthy.” However, he said depression begins to veer into a health problem when the symptoms become burdensome—when the symptoms themselves starts to interfere with a person’s functioning, such that they can’t work, or their relationships are damaged. It becomes especially dangerous when, in an effort to escape that burden, people start thinking about suicide.
There are a number of clinical guidelines to help health professionals evaluate where a person might be on the spectrum. Patten said that clinical psychologists and psychiatrists generally view depression as a diagnostic label, a way of identifying people who are subject to quite substantial episodes of depression. However, guidelines are just that, and he cautions that each person really needs to be looked at individually to understand their particular brand of the disease.
What causes depression?
If defining a disease that unfolds across a spectrum isn’t difficult enough, trying to get a handle on its causes is even trickier.
First of all, Patten said there are many filters through which the causes of depression can be interpreted. For example, neuroscientists might suggest at some level it’s a biological phenomenal, and psychologists and sociologists will bring their own theories and models through which they examine it.
However, Patten said, to his knowledge it has not been possible to look at neurobiological data (like biological blood markers, or brain scans) and pick out where someone might be on the depression spectrum. “I think most scientists, irrespective of their background, would be willing to admit that the precise [cause] really isn’t very well understood for this condition.”
An unsettling thought, when according to the Mood Disorders Society of Canada (MDSC), eight per cent of Canadians will experience major depression in their lifetime. In a population of just over 35 million, that’s 2.8 million people—roughly the population of Edmonton and Calgary combined.
Still, Patten wonders if focusing resources on determining the cause of depression is the way to approach it, and said that generally, there is more interest now in what actually works to treat the patient.
Treatment
Patten stresses that treatment needs to be assessed on an individual level—there are treatments that are effective, but they aren’t equally effective across the entire spectrum.
For example, he pointed to the use of anti-depressants. “For a few years there was an enthusiasm about anti-depressants. That’s been tempered by the observation that they are not very effective at the minor end of that spectrum. However, there’s been the development of a few types of psychotherapy that have been effective at the milder end of the spectrum. There’s also been the observation that some depressions will just go away.”
Patten said that ideally mental health issues would be treated similarly to a disease like cancer. For example, he said “The logical thing might be that if you come to primary care with mild depression, you might get a brief psycho-social intervention, and that would be enough a lot of the time. If it wasn’t, you’d be referred on to a more specialized service.”
But that’s not often what happens, he said. “Quite often, if you come to a primary care practice, and the doc only has five minutes, you might walk away with a prescription, rather than a pyscho-social intervention, and then when it comes time to refer you on to a higher level of service, it might take eight months to get in there.”
The general consensus about the current health care system, he said, is that “It’s very complex, at times inefficient and certainly not well coordinated, and it leads to problems with access.”
Still, Patten said he doesn’t want to sound too pessimistic. There is good work being done to remedy these problems, but there are also huge resource constraints that get in the way of progress.
“When you look at the burden of illness, [mental health] issues are by far the prominent health issues in people up until the age of 50.” Despite this, a much smaller percentage of the resources are directed towards it.
“There is that sort of gorilla in the room—you can’t spend five per cent of a health budget on something that causes 30-40 per cent of the burden of ill health and expect that everyone is going to get what they need.”
Patten said that in the end, though there’s been progress in people’s awareness of depression as a disease, some of it still comes down to stigma.
“If [there’s] a child with a form of cancer whose parents want him to be treated with an extremely expensive drug—where there’s no evidence that it works—then that will be a front page headline when they don’t get what they want,” he said, adding that people starving on the street with mental health issues is somehow not as big an issue.
“This is where the stigma comes in—we live in a culture that separates mind from body.”
Niki Wilson
Special to the Fitzhugh
