Depression and Its Treatment Across the Globe

Known since the time of the Greek physician Hippocrates, over 2,000 years ago, the disorder of depression has received the attention of playwrights (such as Shakespeare), novelists (such as Styron), and much more recently, the providers of the diverse psychotherapies and pharmaceuticals offered to suffering individuals. Psychiatric-mental health nurses are among the vanguard of clinical care providers to depressed children, adults, and elders, making major contributions to the psychological intervention literature (e.g., Beeber et al. (2014) and Peden (1996).

Much more is now known about depression (it’s not an excess of black bile, as thought by Hippocrates). For example, we know that there is hyperactivity in cortical area 25 of the brain, along with underactivity in other parts of the prefrontal cortex, and that depressed people have an enlarged, overactive, amygdala and defective functioning of the hypothalamus (Kandel, 2018). Antidepressants counter the damage done by cortisol and glutamate and promote the growth of synapses in the hippocampus and prefrontal cortex (Kandel, 2018). New hope is being vested in Ketamine, especially to reduce suicidal thoughts, as Kandel explains, “because ketamine acts on the excitatory neurotransmitter glutamate…the drug reduces depression more quickly than drugs that act on the modulatory transmitter serotonin” (2018, p. 69).

Nonpharmacological treatments for depression—in addition to the traditional face-to-face psychotherapies—are being delivered via technology, including such recent innovations as Online Virtual Reality (VR) Therapy, internet-based therapies, text messaging, and mHealth apps (see the excellent review in our March 2019 issue by Decker et al., 2019). Mindfulness was shown to be an effective intervention for depressed women in treatment for opioid use disorder in a study published in our August 2019 issue (Alexander, Kronk, Sekula, Short, & Abatemarco, 2019).

Despite these advances in neuroscience, psychopharmacology, and nonpharmacological treatments for depression, the global prevalence of depression is increasing, not decreasing. Suicide is also increasing globally, especially among occupational groups characterized by prolonged periods of stressful work, with high workloads and poor work-life balance (see Davidson, Proudfoot, Lee, & Zisook, 2019 regarding suicide among nurses). Major Depressive Disorder is predicted to become the leading cause of premature mortality and disability by 2030 (Mathers & Loncar, 2006)—and this prediction is for the high-income countries where people are more likely to have access to antidepressant medications and counseling; (unfortunately, accurate information is not available for many lower-income countries, where even survival itself in contexts of terror, war, or famine can be a daily struggle.) In my own country, Sachs (2018) recently listed depression among the “3 epidemics” afflicting the United States (obesity, substance abuse, and depression), and alarm has mounted in both professional and popular literature about escalating depression and suicide among American college students (see Thomas, 2019). Antidepressants are now being taken by 1 in 8 adults and adolescents in the USA (1 in 5 white American women) (Aviv, 2019).

Despite the indisputable fact that many people experiencing depressive illness do receive beneficial effects from the treatments they receive, dissatisfied clients are also making themselves heard—as in the saga of Kelli Korducki (2019) published in the New York Times. Although she acknowledged her privileged status (i.e., she could afford to see psychiatrists and had insurance) and expressed her gratitude for the benefits of the antidepressant medications she has taken since she was a teenager, she wrote poignantly of her longing for someone who would see her as a whole person, “not just a chemical imbalance.” Another compelling account from the patient’s perspective appeared in a New Yorker story about Laura Delano, who was diagnosed with bipolar disorder in adolescence and given 19 medications over the next 14 years, including Prozac, Lexapro, Lamictal, lithium, and Effexor, among others (Aviv, 2019). The article details her lengthy struggle to stop taking medications, a process about which there is insufficient empirical investigation.

Contributing to the knowledge base about depressive illness, and its assessment and treatment across the globe, is this special journal issue being published in January, 2020, at the beginning of a new decade. Guest editor for this special issue on depression is Barbara Jones Warren, PhD, RN, APRN-CNS, PMH-BC, FNAP, FAAN. She is Professor of Clinical Nursing and Director of the Psychiatric Mental Health Nurse Practitioner Across the Lifespan Specialty Track at the Ohio State University College of Nursing, in Columbus, Ohio, USA. Dr. Warren has contributed to this journal as an author and reviewer for many years, and to the larger psychiatric-mental health nursing literature through authorship of chapters on depression in major textbooks of the field (e.g., Warren, 2012; Warren, 2017). She contributed to this special issue by generating the idea, soliciting articles, reviewing submissions from across the globe, and contributing a manuscript of her own.

I believe this issue will be a seminal contribution to the literature because it highlights (a) up-to-date advances in depression screening (as shown in the article on development of a youth screening tool for primary care workers in South Africa and Zambia); (b) the interconnectedness among depression and severe sociocultural and occupational stressors (as in the articles about farmer suicide and self-immolation survivors); and (c) variations in key aspects of depressive illness related to client age, gender, and/or culture (see articles in this special issue from Europe, Australia, South America, Africa, and North America).

Readers across the globe are invited to contribute to the literature on assessment and treatment of depression by submitting manuscripts to Issues in Mental Health Nursing.