Is Depression Really on The Rise?

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It’s an idea repeated so often that it’s now taken for fact – depression is on the rise.

If true, modern society has messed up.

In 1985, 10% of people had no one to discuss important matters with. By 2004, that number had grown to 25% – one out of every four people! (1)

We’re spending less time with other people, eating worse food, and getting less exercise, sunlight, and sleep.

Surely the rate of depression has gone up.

My father disagrees.

Normally that wouldn’t mean anything to me – he believes lots of crazy things. But he’s a psychiatrist.

Psychiatrists are the ones who invented the scientific study of mental dysfunction.

The field has problems. But they base many of their beliefs off of empirical evidence, not armchair philosophizing, like what used to be common (think Freud and penis envy).

Psychiatry has insights to offer.

Is the idea that the rise of depression is more media sensationalization than hard journalism one of them?

My concerns are with anxiety and depression. I know too little about the less common disorders like schizophrenia to have an opinion there.

I have two complaints.

The first is its squeamishness. For example, for most people an antidepressant is not that much more effective than a placebo. But electroconvulsive therapy (ECT) is faster, safer, and more effective than antidepressents. And yet ECT is recommended only to those patients who’ve tried everything else first. Why? Squeamishness. Yes, memory loss is a serious concern. But for many who’ve lost their will to live and spend hours a day crying, that’s a risk they’re willing to take.

The second is its focus on dysfunction, although this is a wider cultural problem. Most of healthcare is focused on treatment rather than prevention – on prescribing medication rather than encouraging healthy eating. But let’s go beyond prevention.

Insurance covers psychotherapy but not Happier Human coaching; it covers physical therapy but not gym membership. We’ve set the bar too low. Positive psychology is a step in the right direction, but psychiatry could help.

Most people think anti-depressants are okay to move someone from sad to slightly happy, but immoral to move someone from slightly happy to happier. I have no such objection. My only concern is side-effects. Almost no research is done into using drugs to safely making people happier. I’m not talking about snorting cocaine or becoming a pothead – even a drug as safe as marijuana has the side-effect of making some people less productive (and maybe increasing the risk of schizophrenia, although that’s not clear).

There exist some drugs which evidence suggests may be safe for most people and which even after just a few doses can have long lasting beneficial effects. But no research gets done because doing drugs if you’re not sick makes you a lazy hippie. Which is a crazy thing to believe, considering most people consume caffeine every day.

Millions Diagnosed With Depression Every Year

If we count and compare the number of people being diagnosed with depression, we should have the answer.

The National Ambulatory Medical Care Survey (NAMCS) found that the number of people diagnosed with depression has increased by 450% since 1987. (2, 3, 4)

Number of People Diagnosed With Depression Each Year

 
For every person who took an anti-depressant in 1987, there are now more than five.

Depression is not merely ‘on the rise’ – it’s an epidemic, with an estimated cost of nearly $100 billion a year. (5)

But that increase is deceptive. Yes, there are more people getting diagnosed with depression, but there are three explanations for that.

1) Depression has become more common.

2) Anti-depressants have gotten better. Anti-depressants sometimes cause fatigue, heart arrhythmias or cognitive impairment, but these side-effects are rare. In the 1980s they were common. (6)

3) Seeing a shrink is no longer taboo. I’m not going to tell someone on a first date, but I don’t hide the fact that I had trouble with depression growing up. According to the NAMCS survey, less than 20% of people with depression in 1987 sought treatment.

It’s obvious that there’s an obesity epidemic. You can’t pretend to be fit if you’re actually 750 pounds.

The same can’t said of depression – it’s possible to cover up sadness with a fake smile.

What portion of the increase is due to an increased incidence of depression? We need more data to answer that question.

We need to know how many people were depressed, not how many people were diagnosed with depression.

Have You Ever Been Depressed?

Ask a large number of folks who are 25 if they’ve ever had any symptoms of depression. Then ask the same of a large number of folks who are 50. Compare.

But the folks who are 50 have had twice as many opportunities to develop depression. Not a problem.

One study which came out in 2005 adjusted for that.

Age Group

Lifetime Risk of Depression

45-59

2.7%

 

30-44

4.5%

 

18-29

7.3%

 

According to them, 7.3% of those in their 20s will experience clinical depression at least once during their life, if they haven’t already.(7)

That’s a large number – almost three times as large as the number for folks in their 50s.

Not as large as the 450% increase suggested by the first set of data, but still alarming.

And yet, we still need more data.

A number of scientists claim that these results are getting skewed by something called recall bias.

It isn’t that folks in their 50s lived a happier, healthier life. They’ve just forgotten those times that they were depressed.

I’m not talking about dementia, although it does annoy me when my grandfather thinks I’m a girl.

Most people come down with depression when they’re young.

So yes, that 50 year old will be less likely to report having experienced any symptoms of depression. Those two months of lethargy and loss of appetite he experienced after his first girlfriend left him for an older man have been forgotten. That was 41 years ago! Now he’s that older man.

In one study kids were interviewed at ages 15, 16, 18, and 21 and asked about their mental health. Then at age 25 they were asked,

Looking back over your whole life before you were 21, did you ever have a period of at least two weeks when you (a) felt sad, blue or depressed nearly every day? (b) lost interest in most things like work, hobbies or things you usually enjoy?

56% of those who had met the criteria for depression prior to age 21 answered no to that question. (8)

Within just five to ten years, the majority of kids had forgotten about or become too ashamed to admit to their prior experience with depression. Now imagine the same experiment being done again, but from age 15 to 50. What percent of those 50 year olds would remember?

This is great from a mental health perspective – dwelling on unhappiness in the past is no good. But from a science trying to understand what’s going on perspective… it seems like we’ll once again need more data.

Don’t We Have Historical Records?

An accurate analysis wouldn’t rely on a person’s memory – it would rely on historical records.

It would ask a random sample of people in 1990 if they had any symptoms of depression, and then ask the same of a random sample of people ten years later. If more people report having symptoms of depression, we can infer that the rate of depression has gone up.

One study did exactly that, and found no difference. Folks in 1990 were as likely to report depression as folks in 2000. (9)

But a half dozen other studies found the opposite thing, with folks two to three times more likely to report symptoms than a few decades ago. (10)

I asked my dad and he said,

Amit, there’s something methodologically flawed with those six studies, ignore them.

At first I thought he was being ridiculous – simply wishing away evidence which contradicts his opinion. But after doing some more research I realized he might be right. Each of those half-dozen studies had either one or both of the following problems.

1) Response bias – in the 1960s folks were more likely to lie. They were more embarrassed to admit, “yes, after my wife died there was a period where I lost all motivation to live.”

2) Different surveys taken at almost the same time in the same place see different results. In one survey taken in Canada in 2001, the prevalence of depression came out to be 4.8%. In another taken in 2002 also in Canada, the rate came out to 7.4%. (11)

The incidence of depression didn’t increase by 60% in one year. Well, 2002 is the same year that survey came out showing most American teenagers think Canada is an American state. That could be kind of depressing.

But the more likely explanation is that it’s the change in survey which caused the increase, not an actual rise in the rate of depression.

So, one more time… we need more data.

Stalk Me, Please!

To avoid the problem that different surveys give different results, ask the same questions every time.

To avoid the problem that different sub-groups report different rates of depression, follow the same group of people for a few years or ask questions to a large number of people representative of the entire population.

To avoid recall bias, ask folks questions which gauge their current mental state, not their mental state 20 years ago.

Then repeat, year after year after year.

To ensure participants respond honestly there’s little that can be done. But willingness to admit to symptoms of depression is something that changes slowly.

What do we get once we take this all into account?

In one study respondents in 2007 were six times more likely to be depressed or anxious than those in 1938. But how can those results be trusted? Folks in 1938 were more likely to hide symptoms of depression.

The survey used asked over 500 questions, many of which were used to innocuously gauge how likely the person was to lie in order to give more desirable answers. After controlling for the increasing tendency to be honest about one’s problems, the increase fell to 300% – not so great as 500%, but still large. (14)

In another study of 42,000 Americans, the prevalence of depression increased from 3.3% in 1991 to 7% in 2002. (13)

In one longitudinal study of 4,750 Danes, 2% of the sample reported symptoms matching clinical depression in 2,000. Six years later that number had increased to 4.9%. (12)

The exact number varies from study to study, so it’s unclear by how much the rate of depression has increased. But that depression has become more common? That seems certain.

Not once but three times did I discard data because it might not be reliable.

The situation is insane. Not that I had to discard so much data. That regardless of what data we look at, the picture seems to be the same – depression has become more common.

The whole point of economic growth is to improve one’s quality of life. It seems that for many, mental health was left behind.

 

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{ 50 comments… read them below or add one }

Shanna Mann

I’m often chagrined to see how often I take plausible explanations at face value, only to nod my head along in agreement as someone takes me through a critical analysis. Ouch.

For myself, I would have assumed that depression was on the rise for a couple of reasons. One is a recent study showing that people were most suicidal in the happiest countries– the journalistic explanation is that, when faced with so many people living an experience they feel they’ll never have, they decide to end it. Not sure the researchers themselves put forth that theory.

And the other is simply that, as you mentioned, we have more awareness and acceptance of mental health issues, so people are seeking treatment more.

I have one concern about the American study, though. Did they correct for 9/11?

Reply

Amit Amin

Those are some great points Shanna.

I haven’t looked into rates of suicide, but I should. I’m assuming some suicides go uncatched in poor countries, but that’s still useful data.

The American study didn’t correct for 9/11. I didn’t even think of that! I assumed that 9/11 only affected mental health in NYC. But a quick search showed that might not be true. Argh! Thank you 🙂

Reply

Joel Zaslofsky

Good point about correcting for 9/11, Shanna. Another thing that may get lost in translation, especially in the first chart Amit posted in this article (“Number of People Diagnosed With Depression Each Year”): population growth (or decline).

I look at charts like those and wonder if they are the equivalent of investment return charts that don’t account for taxes and inflation. In fact, charts fail to adjust for such common – and important – things like population growth so often that I often dismiss them off-hand unless it’s easy to tell what kind of bias they might have.

Amit, you’re exploring a crucial topic and synthesizing it for mass consumption. Thanks for doing the research and making it accessible for us once again.

Reply

Amit Amin

Yes! Exactly! There are so many charts which fail to adjust for important things like inflation that it’s hard to know what the real picture looks like. Retirement planning charts which don’t take into account inflation or taxes! Argh!!!!

Indeed, I could have easily shown the rate of diagnosis rather than the rate of diagnosis times the population for the first chart. But that would have shown a smaller increase, which hurts the point I wanted to make – the data is not so clear as it looks at first glance.

Reply

Erin

I don’t do a very good job questioning studies, and this post just highlights that fact for me. I know “the numbers” can often be used to justify all kinds of viewpoints, but I don’t often dig into the reasons why, say, a set of numbers might be the way they are. It was quite interesting and illuminating to read your discussion of the various studies out there and what other factors might have been involved.

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Amit Amin

Yeah – I don’t think anyone really does a good job questioning studies, except perhaps in their own field. It takes too much time and domain knowledge. Which is really unfortunate.

The typical news story takes a single research study and reports its findings as truth. When in reality scientists have this process called replication for a reason – a single study presents only a small fragment of the bigger picture.

Reply

NLP TRAINING WORLD

Dear Amit,

This study was a need of the hour and being in the profession of people transformation and mental health, I also see an alarming rise in the number of depression cases in India as well..

As you said rightly in the beginning of your post ” Its because people spend more time with gadgets, have wrong food and only have less sleep…”

This culture is being imbibed by the youth of India as well and in 5 years time from now we will be hitting at-least one psychopath in a distance of 100 meters…

Reply

Reclaiming Your Future

This is a great round up of studies Amit and one that certainly makes me think. I’ve wondered a lot recently about this and think it’s definitely a combination of factors as you’ve mentioned above.

I liken it to the chicken and the egg question; what came first? The increase in depression or the reporting of it.

I still don’t know the answer, like depression it has a host of possibilities but this is definitely one of the smartest posts I’ve read about it – good job! 🙂

Reply

Amit Amin

Yup, it’s a tricky question, one which I still want to learn more about.

When you look at twin studies, where identical twins are raised apart, it seems that barring the most exceptional circumstances, one twin is as likely to develop severe depression as the other, even if they’ve received a healthier diet, exercise, have more friends, etc… Which implies that depression is 100% genetic.

Which makes no sense! Partially genetic I would understand. But 100%? Confusing.

Reply

Natalie

Wow – what a well thought out and articulate article to issues that often seem negative and one-sided. That you for providing this insight and doing a good job providing the stats. 🙂

Cheers, Natalie

Reply

Ethan

I really appreciate all the research you put into this- it’s clear that it’s an important topic to you. My general take on depression and many other psychological conditions is that they *do* exist, but are overhyped by the pharmaceutical industry in order to help drive the need for their drugs. I think everyone naturally goes through some depression at one point or another in their lives– does this mean that they need to be on antidepressants? I don’t think so.

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Amit Amin

The folks who do the research are rarely affiliated with pharmaceutical companies. For example, most of the studies I looked at were done by PhDs, who in turn were sponsored by government grants or by college tuition. Pharma companies spend more than $100 million a year on advertising, so I’m sure that their influence is seeping through. But rather than say that psychological conditions are over-hyped, I’d say anti-depressants are (when in fact there are more effective alternatives).

Two points –
1) Something like 30% of folks with depression have what’s considered severe depression. There’s nothing ‘natural’ about severe depression. Hours spent crying every day, loosing the will to live, massive physical fatigue, etc… for months on end. For folks with less severe depression things like exercise and spending more time with friends can get the job done. But for folks with severe depression it can take everything to get them back to normal, including drugs.
2) Even if depression is over-diagnosed, I think the only downside to anti-depressents besides their side-effects is if it makes a person less likely to change their life in ways that make them happier (e.g. take an anti-depressant instead of improving their relationships). But happiness research suggests that, within reason, the happier a person the more likely they are to be productive. So even though I’m not depressed, if I could take an anti-depressant without crippling side-effects, I would – I look at it like taking coffee.

Reply

Jessie

Suicidal people don’t really need anti-depressants in my opinion, they just need to change their views in life with the help of a psychiatrist or better a friend or a loved one. Pharmaceutical companies are just profiting from these kind of patients.

Reply

DaveK

Your opinion is idiotic and harmful. As above, “views” don’t matter. This is like saying “people who are overheating don’t need to cool down, they just need to change their views about temperature.”

Or saying to a person who just had six shots of vodka, “you can drive, just choose not to be drunk.”

Or saying to someone who is paralyzed from the waist down that they should simply choose to walk.

It is endlessly frustrating that still, with so much more awareness, people insist on holding onto their myths of cartesian dualism, where some magic outside self can simply repair non-functioning parts of the physical brain.

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DaveK

“I think everyone naturally goes through some depression at one point or another in their lives– does this mean that they need to be on antidepressants? I don’t think so.”

Sigh. There is a great deal of confusion with the word “depression” and how people who have never experienced it perceive it. I do think part of the problem is over-diagnosis, leading to confusion amongst people.

But, no, people do not naturally go through depression. It is not the same thing as being sad, or in a bad mood.

The easiest way to understand this for depression-naive people: If it’s “about” something, it’s not depression. Depression isn’t about anything. As in, changes in external circumstances are irrelevant (baring super extreme circumstances, like a preference not to be tortured)

Reply

Larry Jones

I thought the article was extremely poor, not only because it failed to answer the question it posed in the beginning, but because it was also extremely poorly written and did little to address the problems people with depression experience. These included attempted suicide, death from suicide and often the inability to work or even function in society. The article gets a big fat “F” in my book.

Reply

Amit Amin

From the fact that you took the time to comment, I assume you care about this topic. I always appreciate feedback – it helps me improve and hopefully help more folks. So if you have more specific thoughts, that would be really appreciated, especially your thoughts on why the article failed to answer the question posed in the beginning.

As for why I did little to address the problems people with depression experience, that wasn’t the intent of the article. I can only write about so much in a single article. Thanks!

Reply

DaveK

You can find plenty of stuff about this. The article was about whether the rates of depression are rising. Not everything about depression needs a boilerplate explanation of basic info.
If you read an article about this year’s superbowl, you don’t need a description of what football is, the rules of the game, history of the NFL, etc.

Reply

Larry Lewis

As a life coach and personal development blogger it is apparent that the difficulties many face in society and the mounting pressures to simply survive results in people reaching a point where they feel they can’t cope. This is worrying in itself, but what concerns me more is the willingness to prescribe medication to both young and old. There have to be better ways, feeding the mind, body and soul correctly needs to be the starting point. This is where the cure will be found.

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DaveK

And if it turns out the hygiene hypothesis is correct? Or (unlikely) there is some pathogenic trigger?

It’s quite amazing you know where to look for the cure, considering people don’t even know the cause.

Hey guys, no need to figure out alzheimers. I’m sure if those people just ate better and had more meaningful lives it wouldn’t happen.

What worries me, frankly, is that some naive parent will think your services are all their kid needs to “get over” their depression.

It’s funny, people never see the schizophrenic screaming at invisible people and say “you know, if only that person had eaten right and had their spiritual priorities straight, they wouldn’t be arguing with a giant purple cat right now”

Well maybe in less advanced religious societies.

Reply

lynne

Hi, I really appreciate the effort you made for this research, it is very informative . Depression comes to each and everyone of us, It is a matter of how we manage to handle it. It is very interesting to know the stats you mentioned. Through this article, in a way, you can give others a general view on how depression clearly affects our people today. Thanks.

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Shine and Rise

Very much enjoyed reading this article. You bring up some excellent points and you also have the data to effectively make those points. In my opinion – especially when factoring in the rise in depression in teenagers – the way we communicate with each other through technology instead of actual human interaction, is a major contributing factor. Texting and emailing etc., serve to make us feel more isolated and lonely than if we’d had a conversation in person or over the phone. Hearing another person’s voice, making eye contact, having an instant, palpable reaction from another person when we speak, is crucial to feeling connected, heard and compassionate.

While of course there are many other considerations to factor in, I strongly feel that our growing dependency on technology to communicate, is one of the major culprits in the rise in depression.

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trish

I found this article eye opening. It’s about time we start taking depression more seriously. We need more healthcare providers, more places for patients to go. People need more accessible mental healthcare. Working in healthcare it is the least illness treated in a timely fashion. Patients often wait long periods of time to be seen. It is a sad state of affairs. With the statistics out there we should be moving in a direction to make help available to everyone. Lets not wait until its to late those are the statistics we need to avoid. I think every situation has a solution, lets find one!

Reply

Mercury

I don’t think actual depression is increasing – I think our measurements of depression are increasing, just like with every other mental illness. And the problem there is with the ever-broadening definition of depression (so they big pharma companies can sell more and more prescriptions) we’re bound to end up with more “depressed” people year after year.

That’s not to say depression isn’t a real thing. I just think they hand out these mind altering medications all too readily.

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John

Great article. Depression comes in many forms and can often be severe and due to medical reasons. However I do feel that many people nowadays frequently attribute the normal ups and downs in life and moods to depression. It is fashionable to be “treated” for depression and to be on some type of depression medication. It is after all far easier than lifting yourself up, kicking yourself in the pants and getting on with life in a happy cheerful mood.

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lols

hiya,

I was just wondering wether you take into count how many teenagers try to end there life because I know with friends and family being on that kind of state of mind , and also im doing a project for my school project , I would like to know wether in the last 10 years the rate od diagnosed deppersion has been raised, and secondly do you think that being depressed or suffering with depression is a state of mind , a disease or a trend because I know that people think that suffering with depression is a trend and to make them seem cool what do you think about that ?

Reply

james franko

good morning/good evening,

what do you think about people who take pills to make themselves better and what things could people say or do to help their parents/girlfriend/boyfriend/friend/bestfriend.

because I am struggling with to help my girlfriend and im a just wondering what I can do to help because I feel like im worthless and I don’t know what to do when she is crying her eyes out.

because I love my girlfriend so so so much I really do and want to make her happy but I really don’t know what to do or say.

thank you looking forward to your reply

james franko.

Reply

james

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Sandra Mullen

I can’t believe that in 1938 people did not have more depression than in 2017. They were in the middle of a war. I think we need to stop thinking of 2 weeks when we were 16 and feeling sad is abnormal. I think people are no longer growing up having to deal with difficulties and hardships, so they don’t know how to deal with emotions that go up and down. Sadness is a part of life.

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