Rising tide of depressive illness exacting human, economic toll

By ANDRE PICARD
Monday, January 7, 2002  Print Edition, Page A1
From the Globe and Mail, and so is the third instalment, if I can grab it. 

OTTAWA -- During more than a decade of suffering from severe depression, Janice Alexander found that the hardest thing was trying to explain what she was going through. Dealing with people who tried to cheer her up was just as difficult as trying to find the words to respond to those who urged her to "snap out of it." More often than not, she wound up retreating into isolation and silence. "People don't understand that depression is an illness, a physical illness, with physical manifestations," she said. "For me, even talking hurts sometimes."

But after years of treatment, with both powerful drugs and psychotherapy, Ms. Alexander has her condition under control and feels a need to speak out for those who cannot. The 48-year-old Ottawa woman, a former broadcaster and real-estate agent, is candid about her condition, even though she is the first to acknowledge that words cannot adequately convey the plight of a person who is severely depressed. "The best way I can explain it is that I just didn't feel right in my own skin. I was in a constant state of discomfort. And sometimes I would crash down into this place, this place that I don't want to go any more," Ms. Alexander said.

She is not alone. An estimated one million Canadians suffer from some form of depressive illness. The condition is devastating to individuals and their families, and to the social and economic underpinnings of society. According to Health Canada, mental illness -- of which depression is by far the leading problem -- costs the economy at least $13.4-billion annually. While mental-health professionals and consumer advocates have long underscored these numbers, corporate Canada, and to a lesser extent governments, are now paying attention, too. "In Canada alone, we estimate that the cost of mental illness represents nearly 14 per cent of all corporate income," said Michael Wilson, a Bay Street stalwart and former federal finance minister. He said the rising tide of mental illness, particularly depression, has such a devastating impact on the domestic and global economy that it can no longer be ignored. "This is a crisis which, in my judgment, is draining productivity like a slow unseen leak in a ship at sea," Mr. Wilson wrote in a recent letter to Finance Minister Paul Martin and other leaders of the Group of 20 industrialized and developing countries. After his depressive son committed suicide, Mr. Wilson became a crusader for mental health and is senior chairman of the prestigious Global Business and Economic Roundtable on Addiction and Mental Health. In his letter to the world's finance ministers, Mr. Wilson said the already heavy toll of depression threatens to grow worse. He said the pace of life and the demands placed on workers in the modern world "are such that they tend to promulgate mental health problems in the labour force rather than protecting our investment in our people."

Stan Kutcher, head of the department of psychiatry at Dalhousie University and one of the world's leading experts on depression, said that is precisely why governments and corporations should be paying a lot more attention to depression. "As our society moves from being a resource-based economy to a knowledge-based economy, we are becoming more dependent than ever on the brain for our economic well-being," he said. "But there's this strange phenomenon where, at the same time, brain diseases like depression are becoming the leading cause of disability."

The World Health Organization estimates that by the year 2020, depression will be the second-leading cause of disability in the world, trailing only heart disease. Yet, Dr. Kutcher said, trifling amounts of money have been invested in research and treatment of depression, compared to the sums spent on more traditional ailments such as heart disease. "If we were using a population health model, where funding was based on need, things would be very different. Right now, they're clearly out of whack," he said.

The root of the problem is that the functioning of the heart -- healthy and unhealthy -- is far better understood than the functioning of the brain. Dramatic breakthroughs in the understanding and treatment of depression have all been made relatively recently. What scientists have learned is that the causes of the disease are as complex as its symptoms. There is no question that there are biological underpinnings of depression, that disturbances in brain signals, both chemical and hormonal, cause people to be depressed. There is also some genetic basis to the illness, though there is almost certainly not a single gene responsible for depression. Further, it is increasingly clear that there are environmental triggers that cause a "normal" person to become depressive.

The great mystery is how it all fits together: What combination or combinations of genes, brain chemicals and life experiences make people depressed? What scientists do know, increasingly well, however, is how to treat depression. There is now a mind-boggling array of drugs to treat the condition, most of which work on specific neurotransmitters in the brain. Electro-convulsive therapy also brings relief to many people with depression, and there is exciting work being done with magnetic stimulation and pacemakers for the brain.

Combined with education on how to spot the early signs of depressive episodes and coping strategies (notably methods known as cognitive therapy and interpersonal therapy), the treatments have proved effective. "With the treatments we have available today, 60 to 80 per cent of people get a lot better," Dr. Kutcher said. By virtually any measure used in the medical field, that is impressive, but little attention is focused on the success rate of treatment of depression, or the fact that the majority of patients become fully functioning members of society again. "I can tell you that if they had a 60-per-cent success rate in treating bowel cancer, researchers would be crowing from the rooftops," Dr. Kutcher said. "But there tends to be unrealistic expectations. People think that all depression can be treated with a pill."

Bill Gaudette, president of the Canadian Mental Health Association, has the same concern, that policy-makers think there is a magic bullet out there to cure depression when the reality is much more complex. "Treating depression with drugs is great but it's only part of the solution, a quick fix," he said. "In mental health, you have to deal with the whole person, and you have to do it over time. A quick fix isn't going to work." Mr. Gaudette said people suffering from depression endure stigma and a host of related difficulties that flow from their illness, such as lack of employment, unstable housing situations, poverty and relationship problems, and treatment needs to address all these issues, not just brain chemistry. "People with mental illness like depression need access to health care, supportive housing, job support, protection from discrimination -- all the things most Canadians take for granted." Mr. Gaudette said governments and the public must also recognize how commonplace depression has become, and the enormous toll it is taking on society.

It is estimated that one in four women and one in eight men will suffer from a clinical depression at some point in their lives. "There's a lot of lost and scared people out there, and we need to do a lot more for them," Ms. Alexander said. She describes herself as one of the lucky ones because, despite having a severe form of depression, she never lost the support of family and friends, had good insurance benefits and received the "Cadillac treatment." Yet Ms. Alexander is acutely aware that people look upon her differently because she suffered depression and not another common chronic ailment such as diabetes or heart disease. "My one wish after all this is that we would get rid of this idea that being sick from the neck up is any different from being sick from the neck down."

Myth of the sad old lady: back to Millstone