Frequency

How common is depression? This obviously depends on how it is defined, immediately taking us into controversial areas. The standard answer to this question starts with 'major depressive disorder', as defined in the DSM. Community surveys have shown that extraordinarily high numbers of the general public satisfy diagnostic criteria for 'major depression' at any one time; for example, estimates of at least 10 per cent are often quoted, and it is held that 20 per cent or more of the population will experience an episode of depression during their lifetime.

Bipolar affective disorder is at least 10 times less frequent than depression. This is not controversial.

However, regarding unipolar depression, only a few of this 10 per cent are actually in receipt of a diagnosis of depression, let alone treatment for it.

This apparent paradox can be interpreted in various ways. Some would suggest that these undiagnosed 'cases' represent a hidden burden of disease, which must be identified and treated; it has even been suggested that, worldwide, depression is the illness that 'causes the largest amount of non-fatal disability' (Üstün et al., 2004).

This is clearly good news for the makers of antidepressant medications, who have indeed prospered mightily since the definition of major depressive disorder was promulgated from the1980s onward.

Critics of this approach would point to the definition of major depression as having been greatly widened; in other words, they say that the 'bar has been set very low'. They would also suggest a fundamental difference between people consulting a doctor for a health problem and people who may describe similar experiences if they are approached and questioned by researchers, but who on their own have not identified themselves as ill.

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