Depression's invisibility fuels stigma

An international expert described the reluctance in Ireland to seek help for depression as worrying, considering the importance of early intervention

AN INTERNATIONAL expert on depression has expressed concern about the number of Irish sufferers who do not seek medical help.

Toronto-based Prof Sidney Kennedy said early intervention was crucial. But the psychiatrist also conceded that the “invisibility” of the disease continued to fuel the stigma surrounding mental illness.

With an estimated one in four people with depression in Ireland not seeking help, Prof Kennedy said this was worrying, given the benefits of early intervention. “It is considerably worse than Canada, where one in two get help,” he pointed out. The reluctance regarding depression as a medical condition which must be openly discussed and addressed was a widespread problem, he said.

The psychiatrist told of a colleague who recently battled breast cancer and severe depression. When the cancer was diagnosed, she was bombarded with messages of support and “buckets of flowers” arriving at her hospital bed, but months later when she became profoundly depressed it was as if she had been placed in isolation. “There were no flowers, no phonecalls – people still don’t want to address this.”

Prof Kennedy, who was in Ireland recently addressing GPs on advances in treatments for depression, said the debilitating side effects associated with some conventional treatments often prompted sufferers to give up on them. And he said some sufferers were also giving up on antidepressants because it takes some antidepressants so long to have an effect. “They may start to work after three or four weeks, but that is no good to the person who flushes them down the toilet after two weeks because nothing is happening,” he said.

An advocate of a controversial surgery used to treat adults with severe depression who have not responded to other treatments, Prof Kennedy said there had been huge advances in treatments in the past 20-30 years.

Deep brain stimulation (DBS) involves the insertion of wires into part of the brain “to alter the circuits involved in depression” while the patient also has a pacemaker inserted beneath the skin around the collarbone.

Prof Kennedy said trials on about 40,000 depressed patients had been very encouraging, with about 50 per cent showing improvements. DBS has already been used to successfully treat other conditions such as chronic pain and Parkinson’s disease.

“Maybe in 10-15 years’ time this neurosurgery will be less invasive, and it may well be possible, for example, to do it by laser,” said Prof Kennedy. He said the key to treating patients with depression was to begin with the least invasive option.

A professor of psychiatry at the University of Toronto, Prof Kennedy said 8-15 per cent of people would suffer from clinical depression in their lifetime and traumatic events such as job losses made the vulnerable more susceptible. Recession and widespread job losses which were turning many lives upside down in Ireland, made people vulnerable, just as other traumas such as bereavement, he said.

“Some people have a protective gene which makes them more resilient to life’s circumstances,” he said. “Other people are vulnerable and it is important to realise a major episode of depression is a serious medical event and not to regard it as some do, as akin to a bad hair day for the sufferer.”

Hopelessness, sadness, complete loss of energy, sexual dysfunction, sleep disruption and a feeling that life is not worth living were among the symptoms for those with serious depression.

“I think people have a vulnerability at times like this,” said Prof Kennedy. “Most of us have a set routine or rhythm to our life which may involve going to work in a bank or a hospital,” he said. “The fixed rhythms in our lives also involve eating and sleeping, our social lives and our relationships and when the rhythms are disrupted, some people become vulnerable.”

His visit to Ireland coincides with the launch here of Valdoxan, an antidepressant he has endorsed for the manufacturers.

Prof Kennedy said some people were resistant to all medications and other options such as neurostimulation of the brain were a possibility. He said that, while ECT also carried a burden of side effects such as memory loss, it worked for some sufferers.

He also said that the key, as far as treatment was concerned, was to seek help as early as possible and to investigate the least invasive methods of treatment first.