John Waters (the columnist, not the other one - don’t confuse them!) is quoted in
Age-standardised disability-adjusted life year (DALY) rates from Unipolar depressive disorders by country (per 100,000 inhabitants). (Photo credit: Wikipedia)
today’s Sunday Independent as follows:
“I don’t believe in depression. There’s no such thing. It’s an invention. It’s bullshit,” he said, “it’s a cop out.”
To which I can only say ‘wow’! There are at least two possibilities here. The first is that he has been misquoted, or that there are substantive elisions around the quote which provide some form of moderation (like he is speaking about the universe of possibilities for himself, as in ‘I don’t do depression, personally’).
The other possibility is much more straightforward: John has been accurately quoted and he truly believes this about depression. In which case, this statement brings to mind Wolfgang Pauli’s remark: ‘It is not even wrong’.
Then I wondered where to start.
I could have started by citing the DSM-IV definition:
‘a person who suffers from major depressive disorder must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a two week period. This mood must represent a change from the person’s normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. A depressed mood caused by substances (such as drugs, alcohol, medications) or which is part of a general medical condition is not considered to be major depressive disorder.’
I had thought about providing a whole bunch of references to actual clinical evidence (maybe even citing some some individual personal testimony, or perhaps even thoughts from a famous person). Or some evidence on treatment; or even some material from a textbook.
Of course, I might be wrong, and what I’ve been teaching students is all wrong:
(Depression, the common psychological disorder, affects about 121 million people worldwide. World Health Organization (WHO) states that depression is the leading cause of disability as measured by Years Lived with Disability (YLDs) and the fourth leading contributor to the global burden of disease. By the year 2020, depression is projected to reach second place in the ranking of Disability Adjusted Life Years (DALY) calculated for all ages. Today, depression already is the second cause of DALYs in the age category 15-44 years.) .
And I wondered if I should cite this major study:
Depressive disorders were a leading cause of burden in the Global Burden of Disease (GBD) 1990 and 2000 studies. Here, we analyze the burden of depressive disorders in GBD 2010 and present severity proportions, burden by country, region, age, sex, and year, as well as burden of depressive disorders as a risk factor for suicide and ischemic heart disease.
Methods and Findings
Burden was calculated for major depressive disorder (MDD) and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability (YLDs) and disability adjusted life years (DALYs). Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders.
Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2% (5.9%–10.8%) of global YLDs and dysthymia for 1.4% (0.9%–2.0%). Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5% (1.9%–3.2%) of global DALYs and dysthymia for 0.5% (0.3%–0.6%). There was more regional variation in burden for MDD than for dysthymia; with higher estimates in females, and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%–3.8%) to 3.8% (3.0%–4.7%) of global DALYs.
GBD 2010 identified depressive disorders as a leading cause of burden. MDD was also a contributor of burden allocated to suicide and ischemic heart disease. These findings emphasize the importance of including depressive disorders as a public-health priority and implementing cost-effective interventions to reduce its burden.
But then I wondered if I should bother…