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|Clinician's Digest - Page 3|
According to the World Health Organization, the economic and societal consequences of depression make it the fourth costliest disease in the world. In the United States alone, depression costs more than $2 billion annually in direct treatment expenses and more than $23 billion in lost productivity. By 2030, depression is projected to be the number-one disease burden in high-income countries, surpassing HIV and heart disease. The leap to number one will occur because, despite the trumpeted effectiveness of antidepressants (whose therapeutic impact has been increasingly shown to be overstated) and the billions of dollars invested in developing and studying pharmacological, psychotherapeutic, and surgical treatments, depression's incidence is projected to remain at the same or slightly increased levels, while HIV and heart disease's incidences are projected to decline.
Depression breeds depression. The earlier in life depression occurs, the more likely it'll recur; the longer it goes untreated, the more difficult it is to treat; and children of depressed parents are significantly more likely to develop depression. So while the lion's share of research money and clinical attention goes to treating depression, it also makes sense to look at preventing it.
A recent metanalysis of 19 depression-prevention trials, reported in the October 2008 American Journal of Psychiatry, presented some encouraging news about the possibility of staving off depression. The educational and therapeutic prevention programs included in the metanalysis targeted both general populations and at-risk groups like pregnant and post-partum women, adults with sub-threshold depression, senior citizens with macular degeneration, and adolescents with a familial history of depression. The interventions included psychoeducation, problem-solving and support groups, cognitive-behavioral therapy (CBT), and Interpersonal Psychotherapy. (For an example of a CBT prevention program for adolescents, see http://www.kpchr.org/public/acwd/CWS_MANUAL.pdf.)
Considering the personal and social costs of severe depression, it's encouraging that all the prevention programs studied proved effective, particularly those that targeted at-risk populations. What's even more encouraging was that the results were as impressive as they were without the inclusion of two of the most promising interventions: CBT-based mindfulness meditation, developed by Zindel Segal, Mark Williams, John Teasdale, and Jon Kabat-Zinn, and Internet-based programs for adolescents, such as MoodGym (http://moodgym. anu.edu.au) and CATCH-IT (http://catchit-public.bsd.uchicago.edu).
With research money usually geared more toward treatment than prevention, the accumulating evidence supporting depression prevention may help readjust funding priorities, so that resources can go toward interventions with the most impact for the greatest number of people to reduce depression's enormous human and financial cost.