Back to the National Depression Initiative Q&A that I complained about yesterday, and in Question 6 we have the wee gem:
Depression is an avoidable cost for individuals and society.
Huh. So, I can see what they’re saying maybe, if we’re talking about mild to moderate depression that responds well to early intervention and treatment. The burden of disease for these people can be, for the most part, avoided. Ten points for the health system! Cheap effective treatment. It’s a health budgeter’s dream.
This isn’t talking about mild to moderate depression. It explicitly talks about people with major depression, talking about the quality of life issues that severely depressed people have. Saying that depression is ‘an avoidable cost’ for people who have depressive episodes like mine is a cruel joke.
The thing about major depression is that it seriously affects people who have it. It’s called major because it has a major effect on people’s lives. By definition, it’s rather a big deal.
It can be mitigated by early treatment, and those who suffer from it can suffer less and lose less quality of life from this prompt treatment. People who respond well and quickly to SSRI treatment have the potential to continue to live relatively normal lives. But that’s not avoiding the cost to people – it’s mitigating it. Maybe it’s still an acceptable way to word it, I guess.
People with treatment resistant depression can look at that statement up there and laugh bitterly. for them, for me, it’s not avoidable. To suggest that it is discounts our lived experience. It doesn’t matter how early anyone caught my depression – standard treatment with SSRIs didn’t work, and trialling two or three is three to six months of getting steadily worse. Then there’s another six months of throwing everything at the wall and seeing what sticks. Then another however many months of recovering from the worst of it. It’s not avoidable. It’s just hell.
The Ministry specifically talks about those that suffer worst from depression, then ignores the ones that do not respond to the prescribed treatment they lay out. And there are a lot of people with major depression that don’t – depending on who you ask, response rates are around 40-60%, with a 30-45% remission rate (so 40-60% of people will see some change, and 30-45% will actually get better). Other sources state that up to two thirds of people with major depression do not achieve remission on SSRIs. Those are pretty big numbers, and given that the first-line treatment is SSRI therapy . . . well. That doesn’t seem to me like people who are really unwell, who don’t respond to SSRIs, are avoiding the cost to themselves, nor does society avoid the cost of their illness.
Again, the National Depression Initiative is trying to paint a positive picture, but its not an inclusive one. It makes the really unwell feel like they’re an unnecessary burden, like if they just did treatment properly and hurried up and got better, they wouldn’t be such a problem. It’s another poisonous message.