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Conquering Depression World Health Organization Regional Office for South-East Asia New Delhi SEA/Ment/120 Distr: General Conquering Depression: You can get out Authors of the blues Coordinating Author: Contents Dr Sudhir Khandelwal Department of Psychiatry All-India Institute of Medical Sciences New Delhi, India INTRODUCTION 6 HISTORICAL BACKGROUND 10 Co-Authors: MYTHS AND MISCONCEPTIONS ABOUT DEPRESSION 14 Dr AKMN Chowdhury H.no. 6/C WHAT IS DEPRESSION? 18 12/10 Mirpur Dhaka, Bangladesh DIAGNOSING DEPRESSION 30 Dr Shishir K. Regmi Department of Psychiatry SOME FACTS AND FIGURES 32 Institute of Medicine Kathmandu, Nepal CONSEQUENCES OF DEPRESSION 37 Dr Nalaka Mendis Department of Psychological Medicine WHAT CAN BE DONE? 40 Faculty of Medicine Colombo, Sri Lanka Dr Phunnappa Kittirattanapaiboon Suanprung Psychiatric Hospital Chiang Mai, Thailand © World Health Organization 2001 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. ! Paintings on pages 9, 17, 21, 26, 36 and 41 have been contributed to WHO by Ms. Yogeeta, an eminent artist. ! Paintings on pages 13, 34, 39 and 45 are part of a WHO-sponsored global school contest on mental health for children aged 6-9 years. ! Computer graphics on pages 6, 15, 19, 23, 24, 28, 31, 33, 38, 43 and 46 were created at Exposure Multiples. SEA/Ment/120 Distr: General Conquering Depression: You can get out Authors of the blues Coordinating Author: Contents Dr Sudhir Khandelwal Department of Psychiatry All-India Institute of Medical Sciences New Delhi, India INTRODUCTION 6 HISTORICAL BACKGROUND 10 Co-Authors: MYTHS AND MISCONCEPTIONS ABOUT DEPRESSION 14 Dr AKMN Chowdhury H.no. 6/C WHAT IS DEPRESSION? 18 12/10 Mirpur Dhaka, Bangladesh DIAGNOSING DEPRESSION 30 Dr Shishir K. Regmi Department of Psychiatry SOME FACTS AND FIGURES 32 Institute of Medicine Kathmandu, Nepal CONSEQUENCES OF DEPRESSION 37 Dr Nalaka Mendis Department of Psychological Medicine WHAT CAN BE DONE? 40 Faculty of Medicine Colombo, Sri Lanka Dr Phunnappa Kittirattanapaiboon Suanprung Psychiatric Hospital Chiang Mai, Thailand © World Health Organization 2001 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. ! Paintings on pages 9, 17, 21, 26, 36 and 41 have been contributed to WHO by Ms. Yogeeta, an eminent artist. ! Paintings on pages 13, 34, 39 and 45 are part of a WHO-sponsored global school contest on mental health for children aged 6-9 years. ! Computer graphics on pages 6, 15, 19, 23, 24, 28, 31, 33, 38, 43 and 46 were created at Exposure Multiples. Message from the Regional Director Preface Populations of Member Countries of the World Health Organization's To express emotions, such as, happiness, anger, anxiety, fear or South-East Asia Region have suffered for ages from many sadness, is normal for every human being. So for "sadness" and communicable diseases. While some of these have been successfully "depression", Emile Durkheim, the famous French sociologist and controlled, others continue as serious public health problems. However, philosopher, has very appropriately written: "Man could not live if he recently, it has become increasingly clear that noncommunicable were entirely impervious to sadness. Many sorrows can be endured only diseases, including mental and neurological disorders, are important by being embraced, and the pleasure taken in them naturally has a causes of suffering and death in the Region. An estimated 400 million somewhat melancholy character. So, melancholy is morbid only when it people worldwide suffer from mental and neurological disorders or from occupies too much place in life; but it is equally morbid for it to be psychosocial problems such as those related to alcohol and drug wholly excluded from life". abuse. Our Region accounts for a substantial proportion of such people. Thus, the Region faces the double burden of diseases -- both Depression is certainly not a new disease. It is only the recognition of its communicable and noncommunicable. Moreover, with the population magnitude and the suffering it causes to people, which is a recent increasing in number and age, Member Countries will be burdened phenomenon. WHO data suggest that in 1990 unipolar major with an ever-growing number of patients with mental and neurological depression was already a leading cause of disability worldwide with the disorders. burden from depression increasing in both developed and developing countries. However, very few people are aware of the magnitude of the As Dr Gro Harlem Brundtland, the Director-General of the World Health suffering from depression in the community. Organization says, "Many of them suffer silently, and beyond the suffering and beyond the absence of care lie the frontiers of stigma, Despite the seriousness of depression as a disease and the availability shame, exclusion and, more often than we care to know, death". of effective treatment, only 30% of cases worldwide receive appropriate care. Regrettably, the situation is much worse in the While stigma and discrimination continue to be the biggest obstacles Member Countries of the WHO South-East Asia Region. facing mentally ill people today, inexpensive drugs are not reaching many people with mental and neurological illnesses. Although With the availability of newer medications, non-pharmacological successful methods of involving the family and the community to help in therapies like psychotherapy and cognitive therapy, and the abundant recovery and reduce suffering and accompanying disabilities have social and family support available to patients in our Region, there is been identified, these are yet to be used extensively. Thus, many absolutely no reason why any one should continue to suffer from population groups still remain deprived of the benefits of advancement depression. in medical sciences. Dr Brundtland has said, "By accident or design, we are all responsible for this situation today." This document, prepared by a panel of experts from the Region, provides valuable information on the current state of knowledge about The World Health Organization recently developed a new global policy depression. More importantly, it describes ways and means by which and strategy for work in the area of mental health. Launched by the anyone "can get out of the blues". Director-General in Beijing in November 1999, the policy emphasizes three priority areas of work: (1) Advocacy to raise the profile of mental health and fight discrimination; (2) Policy to integrate mental health into Dr Vijay Chandra the general health sector, and (3) Effective interventions for treatment Regional Adviser, Health and Behaviour and prevention and their dissemination. The South-East Asia Regional World Health Organization Office of the World Health Organization is committed to promoting this Regional Office for South-East Asia policy. Mental health care, unlike many other areas of health, does not generally demand costly technology. Rather, it requires the sensitive deployment of personnel who have been properly trained in the use of relatively inexpensive drugs and psychological support skills on an outpatient basis. What is needed, above all, is for all concerned to work closely together to address the multi-faceted challenges of mental health. Dr Uton Muchtar Rafei Regional Director World Health Organization Regional Office for South-East Asia Message from the Regional Director Preface Populations of Member Countries of the World Health Organization's To express emotions, such as, happiness, anger, anxiety, fear or South-East Asia Region have suffered for ages from many sadness, is normal for every human being. So for "sadness" and communicable diseases. While some of these have been successfully "depression", Emile Durkheim, the famous French sociologist and controlled, others continue as serious public health problems. However, philosopher, has very appropriately written: "Man could not live if he recently, it has become increasingly clear that noncommunicable were entirely impervious to sadness. Many sorrows can be endured only diseases, including mental and neurological disorders, are important by being embraced, and the pleasure taken in them naturally has a causes of suffering and death in the Region. An estimated 400 million somewhat melancholy character. So, melancholy is morbid only when it people worldwide suffer from mental and neurological disorders or from occupies too much place in life; but it is equally morbid for it to be psychosocial problems such as those related to alcohol and drug wholly excluded from life". abuse. Our Region accounts for a substantial proportion of such people. Thus, the Region faces the double burden of diseases -- both Depression is certainly not a new disease. It is only the recognition of its communicable and noncommunicable. Moreover, with the population magnitude and the suffering it causes to people, which is a recent
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