Dr. Narcís Cardoner, director of the psychiatry service at the Sant Pau hospital in Barcelona, ??is one of the most authoritative Catalan medical voices on mental health problems. On the occasion of World Day to Fight Depression, the psychiatrist and associate professor at the Autonomous University of Barcelona (UAB) reviews the challenges still posed by the treatment of a very disabling disease that affects 5% of the population and continues carrying a strong social stigma.
“It is one of the most unfair diseases,” says Cardoner, who directs the working group on complex depression resistant to treatments of the Catalan Society of Psychiatry and Mental Health, an entity that he chaired for four years until 2021. According to the doctor, despite progress, there are still 30% of cases unresolved.
Is depression treated better now than years ago?
If you had asked me ten years ago I would have told you that we were stagnant, but we have improved, now I am optimistic. We have more knowledge of the disease and a broader range of treatments.
Are there many cases of resistant depression?
It depends on how you define it, but if we take the most accepted definition of resistant depression as a reference, between 20 and 30 percent of cases do not respond to at least two treatment strategies.
That means that 70% of depressions do resolve.
Yes, that’s an optimistic way of looking at it. But there is still a significant percentage of people who do not recover. In the treatment of depression we still have many needs to cover.
Which is it?
Depression is the most common mental disorder and has a very negative impact on a person’s quality of life. The more serious, the worse the impact, even now we know that it directly affects life expectancy. People with depression are more likely to suffer from other illnesses and die prematurely.
It is a very disabling ailment.
The forecast is that by 2030 it will be the first cause of lost useful years. Depression mainly affects between the ages of 18 and 65, and those are a person’s productive years. I hate to put it in economic terms, but it serves to illustrate the impact of the disease. Depression entails a significant loss of people’s productivity; those who suffer from it stop working, take very long sick leave that can end in permanent disability.
The most common mental disorder, he says.
In mental health there are two common illnesses, depression and anxiety disorders. And depression has a very high prevalence. According to the latest health survey in Catalonia, it is 7%, and varies greatly between men and women. In women it is around 9% and in men, 5%.
Cultural issue?
It is a very complex issue, even biological factors intervene. We know that the prevalence of depression in women increases when there are hormonal changes, in adolescence, after childbirth, in menopause… There are biological factors, but social factors cannot be ruled out either. The discrimination that women have suffered and continue to suffer makes them more vulnerable to developing depressive symptoms. It is also true that women tend to express emotional discomfort in the form of depression and, probably, men express it differently, for example, with aggressive behavior or substance abuse.
There is a lot of talk lately about the increase in mental health problems among young people.
Yes, and it’s true. We see it every day in emergency and outpatient clinics and it is difficult to understand what has happened. The impact of the pandemic has been very clear. Depressive symptoms have increased by 30%, and are cases, above all, of adolescents and young women.
How can parents know when their teen needs help?
I think there is a good job being done, in general, to visualize mental health problems. Then you have to know that, in very young people, depression does not express itself like it does in adults. Young people can become more irritable, reduce their socialization, fail at school, turn to drugs… and these can be symptoms of depression. Sadness is the first image that comes to mind when we talk about depression, but with young people it does not necessarily manifest itself that way.
And in adults, yes?
It is what we most link to depression, but it is true that the sadness of a depressed person has to be persistent, and interfere a lot with their life. Sadness is one of the two important symptoms of a depressed person. The other is the loss of the ability to enjoy things, to stop doing them, of lack of motivation, of the loss of the ability to feel pleasure.
Isn’t being depressed the same as having depression? How do they differ? Does it depend on how long it lasts?
It’s complex. Being sad is a normal emotional response. People, in certain situations, can respond with sadness, and that is normal, we have to learn to live with it. But when this sadness persists, interferes with the person’s life and is accompanied by other symptoms, that is when we begin to consider the diagnosis of depression.
When is the time to act?
We must seek help when it begins to affect our lives. Patients give up things because they don’t feel like it, they don’t have the ability to do things, to face the day, and these interferences are a clear alarm signal. Also when negative thoughts appear that are not very common in us, which can lead us to think about giving up the towel, about stopping fighting, when you think that it would be better if you didn’t get up one day. It is important to overcome the stigma of asking for help for what we feel. In mental health we often take responsibility for the discomfort, we believe that we are the ones who caused it and who have to solve it.
Does the depressed person think it is their fault?
Depression is one of the most unfair diseases. It makes you suffer a lot. It is unfair, it is one of the few diseases in which the patient is guilty of the suffering, and is responsible for his own suffering and the discomfort it generates in others. And that allows us to understand that to mitigate this pain, many people think about taking their own lives. Depression is the first cause of suicide.
When you live with a depressed person, what should you do?
It is very difficult to answer that question. First you have to understand, convey what depression is, remove the blame, tell them that if they have depression it is not their fault. You have to accompany the person, be with them, and that is difficult because seeing how they suffer and not being able to do anything is difficult.
Is there anything to avoid saying to a person with depression?
Those phrases like ‘come on, cheer up’, ‘do your part’, ‘you can do it’, ‘you have to make an effort’… are recommendations made in good faith but they generate enormous frustration. Precisely what a depressed person cannot do is cheer up. It’s like telling a lame person to walk: if he doesn’t walk it’s because he can’t.
There are experts who believe that it is not good to talk so much about depression in public
It is a very controversial topic. On the one hand, talking about mental health is important because it allows us to fight stigmas and many people access help resources, but it is true that talking a lot sometimes generates unrealistic expectations. Emotional discomfort is something very broad, and we have to understand that life involves a certain degree of emotional discomfort, and we must know how to deal with it. Not all situations of emotional distress have to do with something clinical like depression.
Is depression a disease of our times?
That’s what they say and surely social evolution conditions the appearance of emotional discomfort, but it must be said that depression has been present in humanity since its beginnings. It is a pathology that has accompanied us since ancient times. It is not an invention of the 21st century.