Julie Kanya delves deeper into why we’re down with depression

"Melancholia I" by Dürer

As mankind trots throughout the ages, it appears that every époque has a defining ailment that reflects our eclectic species’ evolution. The bubonic plague cast an ominous shadow over the Middle Ages, tuberculosis was emblematic of the 19th century, whereas HIV and AIDS individualized the late 1980s. Right now, science is struggling to defeat the enemy within – cancer, or ‘the emperor of all maladies’, as it has been dubbed by Pulitzer-winning physician Siddharta Mukherjee. But are we so focused on the rare and phenomenal minute detail that we forget to cast a critical glance on the bigger picture? If so, one might realize that today’s ‘common cold’ is actually the melancholia of tomorrow.

Depression is defined as a mental disorder that presents with low mood, loss of interest and pleasure (anhedonia, if you really want the proper term), disturbed sleep and feelings of low self-worth. Granted, we all feel a bit under the weather from time to time, but naturally snapping out of it is the cure in most cases. However, the problem can become chronic and significantly impair the affected individual, leading to tragedies such as suicide, which is associated with around 850,000 deaths every year. According to the World Health Organization, by the year 2020 depression is likely to be the 2nd leading contributor to the global burden of disease. At the moment, it affects around 121 million people worldwide (whereas cancer, which is still a prominent cause of ubiquitous mortality, accounted for approximately 7.6 million deaths in 2008). But surely this is not all doom and gloom, is it? The human species has been lucky, mostly because the 19th century also meant the development of a novel branch of biology, namely that of pharmacology, dedicated to artificially fixing nature’s mishaps.

Antidepressants were stumbled upon in the 1950s, when various opiates and amphetamines (now withdrawn due to their addictive nature and side-effects) were employed as ‘nerve tonics’. But it wasn’t until 1957 that iproniazid, a drug initially trialed as an anti-tuberculosis agent, was shown to have a great ‘psychostimulant’ effect – thus, the first monoamine oxidase inhibitor was brought to light. Research into this field was fruitful, and now many different categories (including selective serotonin reuptake inhibitors such as the infamous Prozac or tricyclic antidepressants like imipramine) are clinically available and widely used – but to what avail? A number of recent articles claim that they’re nothing but the evil work of the wicked Big Pharma, whereas others try to defend their actions. Truth be told, the reality is probably somewhere in the murky middle: the theories of what actually causes depression are far from being confirmed, and at the moment most of the treatment is based on scientific best-guesses – and so it’s not a major surprise if a placebo actually has a significant clinical effect!

All things considered, maybe both happiness and depression can hit you like a train on a track. Still, the latter tends to strike a lot harder and cunningly, for reasons yet largely unknown: is it in your genes? Is it in the environment? Is it a bit of both, and what can you do about it? As clichéd as it may sound, the best advice this writer can give is ‘Keep calm and carry on’ – the best antidepressant seems to be a smile on your face!

 

Julie Kanya

 

Image by Wikimedia Commons