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Quick language clarification: Towards the beginning of this episode, host Caroline Leland uses the word “extreme” to describe threshold criteria for a Major Depressive Disorder (MDD) diagnosis. In this context, a more precise word would have been “persistent” or “chronic.” Presenting symptoms do not need to be any particular level of intensity in order to be valid criteria for diagnosing MDD, but they do need to present chronically, or more often than not.




  • Introduction to Lucero Sifuentes
  • Sifuentes’s description of her emotional experiences with depression
  • Conversation about the challenges Sifuentes faced getting through school



  • Statistics about prevalence of mental health and depression
  • Cost to society in financial terms
  • Discussion about depression and suicide
  • Sifuentes’s perspective on awareness and “coming out of the shadows”



  • Caroline Leland – Freelance Journalist; Contributing Factors Host & Producer
  • David Shifrin – Health:Further Community Editor, Contributing Factors Executive Producer
  • Lucero Sifuentes – Individual living with Major Depressive Disorder
  • Hannah Sanii – Clinical Social Work Associate, Gaston Family Health Services
  • Mary Carter – Psychiatric Nurse Practitioner, Nashville Renfrew Center

Notes On the Healthcare System:

Our healthcare system, and by extension, our economy, is in trouble. The current situation is not sustainable so we must come up with ways to deliver better care more efficiently. And we need to do it now.

Prevalence of Mental Illness:

    • Mental Health by the Numbers (National Alliance on Mental Illness)
    • Mental Health in the Workplace (World Health Organization)
    • World Mental Health Day 2017 (Fortune)
      • One in five adults experiences mental illness in a given year. That’s double the percent of adult Americans with diabetes. In theory, you could think about the number of people you know with diabetes, and then assume you know twice as many people with a mental illness.
      • In a given year, 1 in 25 adults in the U.S. experiences a serious mental illness that substantially interferes with major life activities. That’s more than double the number of Americans with red hair. In theory, you could think about the number of people you know with red hair, and then assume you know twice as many people with a severe mental illness.
      • 6.9% (or 16 million) Americans suffer from severe depression. That’s more than the populations of New York City, Los Angeles and Chicago combined. Those are the three largest cities in the US.
      • One study found that only 41% of adults with a mental health condition received help and less than 50% of children 8-15 received mental health services.
      • Less than 20% of Americans with moderate depressive symptoms sought help from a medical professional.
      • A quarter of people in homeless shelters and a quarter of people in prison live with mental illness.

Cost To the Healthcare System and To Society At Large

Quantifying Depression (Center for Workplace Mental Health)

The Growing Economic Burden of Depression in the U.S. (Scientific American)

The economic burden of adults with major depressive disorder in the United States (J Clin Psychiatry)

The economic burden of depression and the cost-effectiveness of treatment (Int J Methods Psychiatry Res.)

    • Recent effectiveness studies conducted in primary care have shown that a variety of models, which enhance the care of depression through aggressive outreach and improved quality of treatments, are highly effective in clinical terms and in some cases on work performance outcomes as well. Economic analyses accompanying these effectiveness studies have also shown that these quality improvement interventions are cost-efficient. Unfortunately, widespread uptake of these enhanced treatment programmes for depression has not occurred in primary care due to barriers at the level of primary care physicians, healthcare systems, and purchasers of healthcare. Further research is needed to overcome these barriers to providing high-quality care for depression and to ultimately reduce the enormous adverse economic impact of depressive disorders.
    • Depression can result in reduced educational attainment, lower earning potential, increased the chance of teenage childbearing, marital instability, higher unemployment, and increased work disability (Kessler, 2012).
    • Depression is the leading cause of disability worldwide, and a major contributor to other diseases (WHO, 2012)
    • A study by the World Health Organization found that serious mental illness cost the global economy $1 trillion in lost productivity each year, and cost America an annual $193.2 billion in lost earnings.
    • For every dollar spent on MDD direct costs in 2010, an additional $1.90 was spent on a combination of reduced workplace productivity and the economic costs associated with suicide directly linked to depression.
    • 90% of those who die by suicide have an underlying mental illness. Suicide is the 10th leading cause of death in the U.S.

History of Psychology (Curr Opin Psychiatry)

    • How we understand and define the brain + the illness has evolved dramatically over time: “the history of psychiatry has tumbled into many variegated nooks and crannies.”
    • Psychiatry and neuroscience is an important area of psychiatric history that was poorly reviewed in 2007, and only a single article, albeit an important one, need be cited, as interest in the history of neuroendocrinology and neuroimmunology starts to develop. Irwin and Miller [25] at the University of California Los Angeles Cousins Center for Psychoneuroimmunology give us an overview of 20 years of progress in ‘depressive disorders and immunity’, concluding that a ‘cytokine model of depression’ offers ‘drug targets for further development’

FAQs on Deferred Action for Childhood Arrivals, aka DACA (New York Times)


  • Original theme music: “Catharsis,” written and performed by Matt Phillips
  • “Burn,” performed by Kutbeats
  • “Verve,” performed by A-GROUP
  • “American Hebrew,” performed by Davis Absolute
  • “Life,” performed by Kevin Graham
  • “Ashes,” performed by C3NC Music


National Suicide Prevention Lifeline: 1-800-273-8255

What to do if you think you might be depressed (

Common reasons people avoid treatment and expert advice on how to get past them (WebMD)

How Can I Get Help for Depression? (

Finding Help (Anxiety and Depression Association of America)

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