The Undercount: To diagnose depression, you have to look for it

TIRED ELDERLY PERSONThe leading cause of ill health and disability worldwide is … depression. The World Health Organization counts more than 300 million sufferers and says the number is growing: they documented an increase of > 18% between 2005 and 2015.

Yet despite these large numbers we surely have an undercount. Take chronic sinusitis. The literature says about 10% of people with CS suffer from depression. But researchers noticed that that number comes from patient self-reporting or a doctor noticing by chance that something’s wrong. What if, instead, we actively looked for depression in the CS population?

A team from the Medical University of South Carolina did just that. Using the gold standard for detecting depression, the Beck Depression Inventory, they administered it to a population of CS sufferers, 6% of whom had previously been physician-diagnosed with depression. Result: they found depression in 31% of that very same CS population – a whopping 5-fold increase.

When a CS sufferer develops depression two things can happen: their CS treatment is undermined because they fail to comply with the prescribed regime, and the patient tends to back away from life, for example, by staying away from work or school – not because of the CS, but because of the depression.

Stanford neurobiologist Robert Sapolsky says there’s one crucial fact we need to get right about depression: that it’s not some “psychic” thing; rather, it’s every bit as biological as, say, diabetes. We don’t sit down a diabetic and say Oh come on what’s with this insulin stuff, stop babying yourself and pull it together, because we understand they can’t control their inner biology. So, too, with depression, says Saplosky, where overproduction of the stress hormones cortisol and adrenaline coupled with the underproduction of that feel-good neurotransmitter dopamine, translates into an internal biological capture that mercilessly drives emotion, thought and behavior – in the wrong direction.

Here’s why this really matters. If we’re seriously underdiagnosing depression in CS patients then where else are we underdiagnosing it? Chronic infections in general can involve multiple hospital admissions and surgeries, stays in the ICU, superinfections, antibiotic related toxicities, and constant anxiety over outcome and reoccurrence. This refers to the over 2 million antibiotic resistant infections that occur every year in the US, of which over 80,000 are “severe” MRSA-driven infections.

If you or someone you know is suffering from chronic disease and you suspect depression, take a quick look at the Beck Depression Inventory’s list of the key symptoms: pessimism, sense of failure, self-dissatisfaction, guilt, punishment, self-dislike, self-accusation, suicidal ideas, crying, irritability, social withdrawal, indecisiveness, body image change, work difficulty, insomnia, fatigability, loss of appetite, weight loss, somatic preoccupation, and loss of libido.

If you think they may apply, you can take and score the BDI test yourself, here.

Dr. Sapolsky reminds us that because depression is so commonly misunderstood it’s one of the hardest diseases for people to admit to. However, we should be no more reluctant to admit to it than a diabetic should be to admit that their pancreas isn’t secreting insulin properly.

In the final analysis, he says, our reluctance to admit to depression simply reflects the biology that we don’t understand.








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