The Rise of Depression

Depression is the number one mental health problem. Rates of depression are continually rising and increasingly striking younger people. Twenty years ago depression in children was almost unknown. Now the fastest rate of increase in depression and suicide is among young people. Such a rapid rate of increase, and the fact that it is differentially striking different groups within society, tells us that we are dealing with a cultural transmitted phenomenon. Depression is the result of an interaction between changing sociological conditions and personal psychology.

Changing environmental conditions have led to a dramatic rise in people’s expectations from life. At the very same time, change is undermining the traditional buffers and social skills that once enabled people to negotiate stressful changes in their lives. It is not hard to see that the rapid rate of technological change, and the increase in material wealth which this has brought about, has raised everyone’s expectations whilst creating job insecurity, increasing stresses on family life and breaking down traditional communities. The trend from the epidemiological studies of the past twenty years is unmistakable – the rate of depression will continue to increase and it will strike at an increasingly younger age. The good news is that massive research, some 100,000 studies, has been carried out into the cause and effectiveness of various treatments for depression. The results are unambiguous. We now know what causes depression, how to treat it and, more importantly, how to prevent its recurrence.

Drug companies are spending over 3 billion pounds worldwide promoting the view that depression is a biological illness that can only be treated effectively with drugs. Their marketing has been all too effective. Today, contrary to overwhelming evidence, this view is still widely accepted in this country. It happens to be wrong. Before considering that evidence, let us first take a look at the rate of depression. At any one time, between 2.3%-3.2% of men are diagnosed as depressed and 4.5% to 9.3% of women. Thus the rate of depression in women is 2-3 times higher. This is not simply due to differential reporting but rather because of the different biological, sociological and psychological pressures on women.

If we look at the rate of lifetime occurrences of depression the same pattern holds. There is one-in-ten chance that a man will develop major depression whilst there is a one-in-four chance that a women will. This finding has major treatment implications.

There are still people operating under the mistaken assumption that depression is an event-driven phenomenon. We now know that depression isn’t caused by specific events per se because the majority of people exposed to adverse life circumstances do not develop depression as a result. Yet a significant percentage of people will. The interesting question is what gives some people immunity to depression yet leaves others vulnerable?

That there is a biological component to depression is undisputed since all our emotions are expressed in the language of biochemistry. The important point is that depression is not caused by adverse life experiences. It is caused by the way we have learned to respond to adverse life experiences. Many people have faced difficult situations in their life without getting depressed. Many parents have lost a child, perhaps one of the most emotionally painful experiences a human being can have, yet they haven’t developed clinical depression. Sure, they grieved, felt sad but somehow they managed to recover and become enthusiastic about life again. Yet I have also met other people who have lost a child, who were still grieving ten years later and in a state of clinical depression. In fact all of us at some point in our lives are going to have to encounter a loss of loved ones, career changes, health changes and other diverse setbacks.

This should lead us to begin to recognise that, if we encourage depressed people to look for the bad things that happened to them, and to explore and open up their hurt feelings, we are doing them a disservice. They may, of course, temporarily feel some emotional relief, but research shows that they are much more likely to stay depressed, and to have repeated bouts of depression, than if they are given a therapy that addresses the underlying psychological process.

In December 1995, the American Psychological Association published a Meta review of hundreds of efficacy studies in a treatment of depression. The evidence was unambiguous-psychotherapy was at least as effective as medicine on all counts and more effective on some. But it has to be the right kind of psychotherapy. The therapy has to be able to teach clients a way of relating to the world that challenges their depressive world view. They have to be helped to discover how to step out of the way they see things, to literally step out of their negative trance.

A depressive lifestyle naturally also affects the relationships that the depressive person is involved in. In at least 50% of cases the depressed person’s family relationships are damaged by the depression. It is very person’s family relationships are damaged by depression. It is very important in such cases to treat the family as well. This is why interpersonal therapy is one of the most successful therapies in the treatment of depression. Depression is both an interpersonal and intrapersonal phenomenon and successful therapy addresses both these perspectives.