Director of the psychiatry service at Sant Pau hospital in Barcelona, ??Dr. Narcís Cardoner is one of the most authoritative Catalan medical voices on mental health issues. On the occasion of World Depression Day, review the challenges still posed by a very disabling disease that affects 7% of the population. “It is one of the most unfair diseases”, says Narcís Cardoner.
Is depression better treated now than it was a few 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 wider range of treatments.
What is the extent of resistant depression?
If we take as a reference the most accepted definition of resistant depression, between 20 and 30% of cases do not respond to at least two treatment strategies. In the treatment of depression we still have many needs to cover.
Which is?
Depression is the most common mental disorder and has a very negative impact on quality of life. Even now we know that it directly affects life expectancy. People with depression are more likely to suffer from other illnesses and premature death.
It’s very disabling.
The forecast is that by 2030 it will be the first cause of lost useful years. I’m sorry to put it in economic terms, but it serves to illustrate the impact. Depression leads to a significant loss of productivity, those who suffer from it take very long absences, which sometimes end up being permanent.
It’s the most common mental disorder, he says.
In mental health there are two common illnesses, depression and anxiety disorders. Depression has a very high prevalence. According to the latest health survey in Catalonia, it is 7%, but it varies a lot. In women it is 9%, and in men, 5%.
Cultural issue?
It is a very complex subject, even biological factors are involved. We know that the prevalence of depression in women increases when there are hormonal changes, during adolescence, after childbirth, during menopause… There are biological factors, but we must not rule out social factors either. Discrimination makes women more vulnerable to developing depressive symptoms.
Lately there has been a lot of talk about the increase in mental health problems among young people.
Yes, and it’s true. We see it daily in consultations and it is difficult to understand what has happened. The impact of the pandemic was very clear. Depression increased by 30%, especially among teenagers.
How can parents know that a teenager needs help from a professional?
I think a good job is being done, in general, to visualize mental health problems. Then you need to know that, in very young people, depression is not expressed as it is in adults. Young people can become more irritable, reduce socialization, fail at school, resort to drugs… and can be symptoms of depression. In young people we do not only see the typical image of sadness.
And in adults yes?
Sadness is what we most associate with depression, but it is true that it must be persistent and interfere a lot with daily 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, lack of motivation, inability to feel pleasure.
When is it necessary to intervene?
When it starts to affect our life. 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 thoughts appear that are not very common in us, especially negative ones. And it is important to overcome the stigma of asking for help. In mental health we blame ourselves, we believe that we are the ones who cause it.
Does the depressed person think it is their fault?
Depression is one of the most unjust diseases, it is one of the few in which the patient feels guilty for the suffering. And this allows us to understand why depression is the number one cause of suicide.
What do you recommend to those who live with a depressive person?
First you need to understand, convey what depression is, remove the blame, tell them that it is not that person’s fault or that they are responsible for the depression. You have to accompany the person, stand by them, and that is not easy.
And something to avoid saying?
Those phrases like “come on, cheer up”, “do your part”, “you can”, “you have to make an effort”… are recommendations made in good faith, but which generate frustration huge What a depressed person can’t do is cheer themselves up. It’s like telling a lame man to walk: he doesn’t walk because he can’t.
