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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.
CHAPTER 1: DEFINING DEPRESSION
- A look into Contributing Factors Producer Caroline Leland’s personal story with depressive symptoms, and her decision to begin taking a SSRI
- Review of the DSM criteria for diagnosing depression
- Conversation between Leland and Executive Producer David Shifrin about her experience:
- Overview of Season 1
CHAPTER 2: WHAT IT FEELS LIKE
- Introduction to Lucero Sifuentes
- Sifuentes’s description of her emotional experiences with depression
- Conversation about the challenges Sifuentes faced getting through school
CHAPTER 3: WHY IT MATTERS
- 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”
PEOPLE
- 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.
- Healthcare is approaching 20% of our ~$20 trillion annual gross domestic product (GDP)
- Healthcare (Medicare and Medicaid) represents the single largest federal entitlement expenditure for our country.
- This fiscal challenge is only going to worsen given the macrodemographics of our country in 2018 (i.e., 78 million baby boomers with an average age 71 today)
- Medicare/Medicaid accounts for almost $28 trillion of the $112 trillion in unfunded liabilities facing our federal government
- Sources:
- The 2017 Long-Term Budget Outlook (Congressional Budget Office)
- Pdf here
- A Summary of the 2017 Annual Reports (Social Security Office)
- Historical National Health Expenditure Data (CMS)
- The US Debt Clock
- The 2017 Long-Term Budget Outlook (Congressional Budget Office)
Prevalence of Mental Illness:
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- 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.)
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- 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)
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- 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)
MUSIC IN THIS EPISODE
- 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
HOW TO GET HELP
National Suicide Prevention Lifeline: 1-800-273-8255
What to do if you think you might be depressed (healthfinder.gov)
Common reasons people avoid treatment and expert advice on how to get past them (WebMD)
How Can I Get Help for Depression? (Healthline.com)
Finding Help (Anxiety and Depression Association of America)
Caroline, I think that it is great (and brave work) that you are doing. With that said, I had some comments and concerns about some of the content and the way in which it was presented. Specifically:
1. The first episode espoused the serotonin-deficiency theory of depression implicitly and explicitly. This theory is widely debunked in academics circles and it’s not supported by data including animal models of depression, experimental reductions in humans, or the onset of action of antidepressants. We CAN measure serotonin, in blood or cerebrospinal fluid but no one would do it because it doesn’t tell us anything about depression per se. It is not egregious that you should talk about this because it is a theory that has been widely marketed by pharmaceutical companies and is widely believed by many. An issue with these “chemical” explanations of depression that they reduce stigma to some extent but they also make people believe that depression is less likely to improve and specifically less likely to improve with psychotherapy. This is not to say there isn’t a role for serotonin in depression but it isn’t to be in some kind of balance (e.g., it may be to promote the growth of neurons in the hippocampus).
2. I think it’s really brave that you shared your experience with depression and that more people need to do this. To be clear, some of the symptoms of depression that are subjective, like fatigue or indecisiveness do not have to be “extreme,” they simply have to be present more often than not. For someone to meet for depression, you have to meet the five symptoms but none of the symptoms have to be extreme or severe. The only exception to this is agitation/retardation which has to be so bad as to be observable. In other words, and weird as it sounds, a person can meet criteria for “mild” major depressive disorder (as I have!). When someone has 1-4 symptoms but they still say they are bothered by them or show work impairment, then they would meet for an “other” category of depressive disorders which includes “Minor Depression.” If the symptoms are chronic (2+ years) but there’s only 2 or more then the person would still meet for a diagnosis, Persistent Depressive Disorder (formerly Dysthymia). I hope that if in the future there is the opportunity to discuss that there are other diagnostic categories that can apply to people who do not meet for MDD, the issue gets raised. I appreciate that your point was by and large that Minor Depression can warrant treatment and I don’t know your individual case to know whether someone would have given you MDD, Dysthymia, or Minor. I just wouldn’t like to see someone think they shouldn’t go to their GP or whatever because they think they won’t meet for depression…
Lorenzo Lorenzo-Luaces, PhD
Assistant Professor
Department of Psychological and Brain Sciences
Indiana University – Bloomington