The burden of depression | Nature

Mental health is gaining acceptance as a medical problem, but progress in finding treatments is being hampered by the stigma surrounding people’s everyday experiences. The most common mental

disorders are anxiety, depression and substance abuse. The comedian and actor Robin Williams was affected by all three — although he had no drugs or alcohol in his body when he chose to

take his own life, as the results of his autopsy showed when released last week. There was much public discussion in the days and weeks after Williams’s death about mental illness, and

depression in particular. Details of his suicide and speculation about the pressures he faced went into lurid and undignified detail. Commentators — both professional and amateur — weighed

in on the validity (or not) of the image of the tragic clown, and the ‘demons’ that got the better of him. Then the debate switched to stigma and its reduction (or not). Even to have such a

conversation was enough for some. Society was able to give itself a pat on the back for being so open about mental illness. But how much of that well-meaning discussion focused on the

reality that people with depression, and other mental illnesses, face every day? For lack of a better way to put a terrible thing, there seemed to be more focus on the glamorous tragedy of

the end, and not so much on the chronic debilitating (and recurring) struggle that came before it. Frankly, it seems that the death of someone with depression is easier to talk about than

the life of someone with depression. That needs to change. Mental illness hits people with a double-whammy. There is the agony of the symptoms themselves: the paralysis of depression, the

frustration of psychosis, the panic of anxiety; and then there is the way in which those symptoms interfere with how the person would otherwise like to live his or her life. (Physical

illness and injury, too, can bring this secondary effect, of course — see the effect on a sports star kept out of action with a broken leg.) _NATURE_ SPECIAL: Depression Better understanding

of mental disorders and honest discussion and acceptance of them can help to reduce these secondary effects, but there is further to go here than even the most optimistic advocate would

admit. The stigma of living with depression and other mental disorders may have been reduced in recent years, as more people describe their experiences, and wildfire social-media campaigns

stamp down on any public statements that could give offence, but the stigma, for example, of being treated for these conditions is harder to shift. Don’t agree? Then where are the popular

media and political campaigns for fairer and better access to drug and psychological treatments? How come new cancer drugs are heralded as miracle cures, whereas antidepressants and

antipsychotics are still whispered about in many countries as part medicine, part magic? Who talks about a struggling diabetic as being ‘off her meds’? The main focus of science and research

is to address the symptoms of mental illness. And as this special issue shows, the need to make progress on this goal, for depression in particular, is colossal. Measured by the years that

people spend disabled, depression is the biggest blight on human society — bar none. Research has struggled to lift the fog. And as a result, more than 350 million people still battle with

the disorder every day. > Neuroscientists and psychiatrists alike must remain open-minded. Only in the past decade or so have the genomic and brain-imaging tools emerged to enable

significant progress on the physical and molecular features of illnesses such as depression. As a result, long-term agendas are shifting, with the US National Institute of Mental Health

leading the attempt to partition mental disorder into component symptoms as a way to examine neural mechanisms. Supporters and critics trade ferocious rhetoric about the promise and pitfalls

of this approach. And whether it will capture the most important determinants of mental illness, or enough of them to justify shifting the bulk of research resources, is a legitimate

question. There is much criticism that the approach overlooks cultural, social and societal factors. True, but productive study of those — within or outside neuroscience — in ways that

translate into clinical benefit has not been cracked with the existing approach either. Neuroscientists and psychiatrists alike must remain open-minded. Genetic and neuroscience techniques

to probe circuits will surely make progress. The fruits of this research will come too late for many people with depression. But, these people still have a crucial part to play. As more

people are willing to talk about their experiences of mental illness — and the trend there seems positive — then important insights about the most relevant behaviours and factors will

emerge. Discussion of mental illness must continue to grow, and to include the lives of sufferers as well as their deaths. RELATED LINKS RELATED LINKS RELATED LINKS IN NATURE RESEARCH

Medical research: If depression were cancer 2014-Nov-12 Mental health: The great depression 2014-Nov-12 Depression: A change of mind 2014-Nov-12 Mental health: Depression needs large

human-genetics studies 2014-Nov-12 Help luck along to find psychiatric medicines 2014-Nov-12 Mental health: A world of depression 2014-Nov-12 Depression: The best way forward 2014-Nov-12

_Nature_ special: Depression RELATED EXTERNAL LINKS RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE The burden of depression. _Nature_ 515, 163 (2014).

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