According to the World Health Organization, depression is the leading cause of disability and the fourth leading contributor to the global burden of disease, projected to reach second place by 2020. There is also strong evidence that it is an independent risk factor for heart disease, and several studies show that prolonged depression is associated with selective and possibly permanent damage to the hippocampus, a region of the brain critical to memory and learning.
Add the fact that 2 percent to 12 percent of depressed people eventually commit suicide, and the [supposed evolutionary] “advantages” of depression suddenly don’t look so good....
What is natural, the thinking goes, is best. If we are designed to suffer depression in response to life’s ills, there must be a good reason for it, and we should allow it to take its painful and natural course.
But unlike ordinary sadness, the natural course of depression can be devastating and lethal. And while sadness is useful, clinical depression signals a failure to adapt to stress or loss, because it impairs a person’s ability to solve the very dilemmas that triggered it.
Even if depression is “natural” and evolved from an emotional state that might once have given us some advantage, that doesn’t make it any more desirable than other maladies. Nature offers us cancer, infections and heart disease, which we happily avoid and do our best to treat. Depression is no different.

8. Prevalence and Treatment of Mental Health Problems

This chapter presents findings on mental health problems in the United States, including the prevalence and treatment of serious psychological distress (SPD) and major depressive episode (MDE) and the association of these problems with substance use and substance dependence or abuse (substance use disorder).

SPD is an overall indicator of past year psychological distress that is derived from the K6 scale administered to adults aged 18 or older in the National Survey on Drug Use and Health (NSDUH). Numerical scores derived from responses to these six questions range from 0 to 24. For this report, a score of 13 or higher is considered SPD. It is notable that the data related to SPD in 2005 and 2006 are not directly comparable with data from earlier years because of study design changes. Further information on the measurement of SPD, the scoring algorithm, and the study design changes is provided in Section B.4.4 of Appendix B.

A module of questions designed to obtain measures of lifetime and past year prevalence of MDE, severity of the MDE as measured by role impairments, and treatment for depression was administered to adults aged 18 or older and youths aged 12 to 17 in 2006. Some questions in the adolescent depression module were modified slightly to make them more appropriate for youths. Given these differences, adult and youth depression estimates are presented separately in this chapter.

MDE is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had symptoms that met the criteria for major depressive disorder as described in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA], 1994). It should be noted that no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders.

An elderly woman's sudden depression turns out to be a side effect of her high blood-pressure medication. <br />
A new mother's exhaustion and disinterest in her baby seem like postpartum depression—but actually signal a postpartum thyroid imbalance that medication can correct. <br />
A middle-aged manager has angry outbursts at work and frequently feels "ready to explode." A brain scan reveals temporal-lobe seizures, a type of epilepsy that can be treated with surgery or medication. <br />
More than 100 medical disorders can masquerade as psychological conditions, according to Harvard psychiatrist Barbara Schildkrout, who cited these examples among others in "Unmasking Psychological Symptoms," a book aimed at helping therapists broaden their diagnostic skills. <br />
Studies have suggested that medical conditions may cause mental-health issues in as many as 25% of psychiatric patients and contribute to them in more than 75%.

According to a Harvard psychiatrist, about 25% of psychiatric patients don't have anything wrong emotionally, just physically, and treating their illness can cure their mental problems. So, you're not depressed after all, you just have lupus, Lyme disease, or maybe cancer....<br />
According to Barbara Schildkrout's new book Unmasking Psychological Symptoms, some of the common things that therapists treat their clients for can be caused with medical intervention....<br />
Just like depression might be caused (or worsened) by the conditions above, if you're anxious you may have an overactive thyroid, if you're irritable you might have a brain injury, if you're hallucinating you might have epilepsy or, you know, a drug problem, and if you're psychotic, it's probably just from a venereal disease, not because of something awful that happened to you in your formative years.

Depressed people consistently see the world around them more realistically than mentally healthy people who are biased toward optimism. Depression makes leaders more realistic and empathetic, and mania makes them more creative and realistic. The same, to a lesser but important degree, goes for people who are neither depressed nor manic, but not mentally healthy either—those with abnormal personalities [such as dysthymics]—a little depressed, low in energy, needing sleep—and the hyperthymic—always upbeat, sleep little, high libido....<br />
Kennedy as mentally ill and Nixon as normal? I define mental health as the absence of mental illness and being within the normal range of personality traits]; Nixon’s biography, looking for the 4 objective markers of mental illness, supports that conclusion. People ascribe mental abnormality to Nixon because they don't like his behaviours; that reflects psychological stigma,] stigma against mental illness, which is really very deep-rooted in our society.

Whether an insulin shortage “causes [schizophrenia], contributes to the disease, or it’s the brain’s response to injury, we don’t know yet.... <br />
"[I]nsulin problems in the brain may, in turn, make people more vulnerable to Type 2 diabetes.” Lab mice modified to block insulin processing in the brain became obese and showed signs of diabetic insulin resistance. <br />
For a while, doctors were treating schizophrenia by putting people into insulin shock. Some, such as John Nash, Jr., the mathematician portrayed in the movie “A Beautiful Mind,” actually benefited, but up to 10% of the patients died, and by the early 1960’s the treatment had been stopped. <br />
In 2005, researchers at Psychiatric Genomics discovered that the same 14 genes that are missing in the brains of people with schizophrenia are also missing in muscle tissue of people with diabetes. In the lab, they were able to increase the availability of those genes by giving insulin, which could lead to new therapies for schizophrenia.

The way primary care is organized and reimbursed by insurance companies probably serves as a barrier to achieving optimal blood glucose control....
Before [Maine's] program existed, 80% of people with diabetes had received an HbA1c test within the past year. After a year, 93% of people had received one. The percentage of people with HbA1c values less than 7% rose from 41% to 49%—a 20% increase. The percentage of people with HbA1c values above 8% decreased from 31% to 24%, and the percentage of people with HbA1c values above 9.5% decreased from 13% to 9%. There were similar results in measures of LDL (or “bad”) cholesterol and blood pressure.
“This is not a question of bad doctors or bad patients...It is a question of a care model that is focused on illness instead of prevention, and systems that have been created that don’t accommodate a change in focus. We’re changing the focus, including offering financial incentives for physicians whose patients do better.”

Eliminating all violence by the mentally ill leaves 95-97% of the baseline level of violence intact.

[Reforms responded to decades of severe, horrifying abuses which those with and without mental illnesses] suffered as a result of permissive involuntary commitment standards...Those who suffered mental illnesses were locked away for years and sometimes decades despite having done nothing wrong and despite not being a threat to anyone, while countless people who simply exhibited strange or out-of-the-ordinary behavior were deemed mentally ill...There is also a large history of the forced treatment of homosexuality as mental 'illness'. [Committing people to mental hospitals is a time-honored way to stifle] individuality and dissent;...China uses that repressive tactic. <br />
[In the] 1960s when thousands of people were incarcerated against their will [there were far more violent attacks on political figures] (MLK, JFK, RFK, George Wallace, Malcolm X, etc.) than there have been during the relatively peaceful time beginning in the 1980s when involuntary commitment became much more difficult.

A 2009 analysis of nearly 20,000 individuals concluded that increased risk of violence was associated with drug and alcohol problems, regardless of whether the person had schizophrenia. Two similar analyses on bipolar patients showed, along similar lines, that the risk of violent crime is fractionally increased by the illness, while it goes up substantially among those who are dependent on intoxicating substances. In other words, it's likely that some of the people in your local bar are at greater risk of committing murder than your average person with mental illness.<br />
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Of course, like the rest of the population, some people with mental illness do become violent, and some may be riskier when they're experiencing delusions and hallucinations. But these infrequent cases do not make "schizophrenia" or "bipolar" a helpful general-purpose explanation for criminal behavior.

''After his condition was diagnosed, [Mr. Pantoliano] says, he realized the difference between being treated for mental illness and other diseases, “Mental disease is the only disease you get yelled at for having.”
As a result, “so many of us hold our secrets inside us,” he adds. “We take them to our grave — and they put us in the grave.”'