Beating ‘the black dog’

Unless you’ve suffered from major depression, it’s difficult to appreciate the devastating impact on every aspect of your life. As William Styron commented, ‘to most of those who have experienced it, the horror of depression is so overwhelming as to be quite beyond expression’.¹ Indeed, depression makes the single largest contribution to global disability.² Now new studies help clarify depression’s risk factors, confirm that antidepressants can help, but are associated with several issues, and underscore the value of non-pharmacological management.

One recent study, for example, reported that older people with major depression tend to have a particularly poor prognosis, even allowing for other risk factors. Researchers enrolled 1042 people aged between 18 and 88 years. Older age was significantly associated with a worse 2-year course for all four outcomes studied: diagnosis of major depression, chronic symptom course, time to remission and change in depression severity. For instance, a diagnosis of depression was still present after 2 years in 36% of people aged 18–29 years compared to 51% of those aged 70 years or older. Furthermore, 18.2% of those aged 18–29 years had a chronic symptom course compared to 40.6% of people aged 70 years or older.³