The Prevalence of Depression
Given the prevalence of treatment-resistant depression, using ketamine for depression to manage it seems like a reasonable approach. Patients with treatment-resistant depression (TRD) typically have a 10 and 20 percent chance of a positive response with traditional pharmaceutical interventions, while recent medical reports that indicate that TRD suffers see a positive response rate between 50 and 80 percent. Given the potential of ketamine in the treatment of depression, it is important to understand the magnitude of the impact this solution could have.
Using Ketamine for Depression: The Solution to Depression’s Exponential Growth?
How Widespread is Depression?
Diagnosing Depressive Disorders is Itself a Challenge
As depressive disorders reach epidemic levels in the western hemisphere, developing effective solutions to manage them requires out of the box thinking. The problem of managing depression stems from the definition of depression to begin with. Consider the following challenges when managing depression:
- Depression, or more accurately major depressive disorder (MDD), while considered one of the largest causes of disability worldwide, is not a single disorder but a large combination of patient/symptom profiles.
- The DSM-5 allows for the identification of 227 depression profiles, each of which meet the requirements of scoring positive on 5 of 9 symptoms, regardless of the fact that there can be large symptom variation between profiles. A large number of MDD criteria include different or and conflict symptoms, such as increased or decreased appetite, sleep, psychomotor coordination or agitation.
- When accounting for differences in sleep, appetite, and psychomotor activation, research found between 945 to 1030 unique symptom profiles. On top of this heterogeneity of depression, many depressed patients present with associated anxiety, somatic, or cognitive symptoms not included in the DSM criteria.
- In regards to treatment resistant depression (TRD), an area of intense research for psychedelics, The Agency for Healthcare Research and Quality states that the typical definition of patients with TRD includes references to those who fail to respond or enter remission after two or more antidepressant treatments provided at adequate dosages for adequate durations
- Much like the challenges associated with diagnosing MDD, the definition of treatment-resistant depression (TRD) varies widely across the clinical and scientific literature. Speaking generally, treatment-resistant depression refers to the failure to obtain an “acceptable” outcome when treating a major depressive disorder.. The literature lacks an adequate delineation of the diagnostic criteria, medication dosage and symptom duration needed to:
- Properly assess patient outcomes
- Translate research findings into clinical practice protocols
- The management and diagnosis of treatment-resistant depression is complicated by nonadherence to treatment of MDD with nonadherence as high as 50% among those treated with antidepressants
Depression by The Numbers
Given the difficulties in defining depressive disorders, which include:
- Major Depressive Disorder (MDD),
- Recurrent Major Depressive Disorder (RMDD), and,
- Treatment Resistant Depression (TRD)
Attempting to come up with one number to define the issue is challenging and it’s better to look at statistical data from a range of sources in order to get a better understanding of the impact of depression.
The too long, didn’t read version of the prevalence and incidence of depression number is that depression is a pervasive issue with wide ranging economic and social consequences that need to be managed. If you want to dive into the details, keep reading below.
The Prevalence of Depression in the United States According to the National Institute of Mental Health
Prevalence of Major Depressive Episode Among Adults
In 2017, the prevalence of major depressive episodes among U.S. adults aged 18 or older was:
- An estimated 7.1% of all adults, or 17.3 million adults had at least one major depressive episode.
- Higher in females (8.7%) versus males (5.3%).
- Highest among individuals aged 18-25 (13.1%).
- Highest among adults reporting mixed ethnic backgrounds (11.3%) versus unmixed.
- Associated with severe impairment in an estimated 4.5% or 11 million of all adults.
- Associated with severe impairment in 64% of major depressive episodes.
Treatment of Major Depressive Episode Among Adults
When is comes to treating major depressive episodes:
- Approximately 65% received treatment from a health professional in conjunction with pharmaceutically treatment.
- 6% of sufferers are treated by pharmaceutical interventions alone.
- 35% of adults with a major depressive episode received no treatment.
Prevalence of Major Depressive Episode Among Adolescents
In 2017, the prevalence of major depressive episodes among U.S. adolescents aged 12 to 17 was:
- Estimated at 3.2 million or 13.3% of the population aged 12 to 17.
- Higher among adolescent females at 20.0% versus 6.8% in males.
- Highest among adolescents a mixed racial background at 16.9%.
- Associated with severe impairment in approximately 2.3 million adolescents or 9.4% of the adolescent population.
- Associated with severe impairment in approximately 70.77% cases.
Treatment of Major Depressive Episode Among Adolescents
When it comes to treatment of depression in adolescents:
- 19.6% received care by a health professional alone,
- 17.9% received care from a health professional and pharmaceutical intervention.
- 2.4% received treatment with medication alone.
- Approximately 60% of those with a major depressive episode did not receive treatment.
The Prevalence of Depression in the United States According to the the CDC
Using the Patient Health Questionnaire (PHQ-9), a symptom-screening questionnaire which allows for criteria-based diagnoses of depressive disorders, the CDC’s National Health and Nutrition Examination Survey, found that during the period from 2013 to 16:
- 8.1% of American adults aged 20 and over had depression in a given 2-week period.
- Women were twice as likely as men to suffer from depression, with 10.4 % of women (10.4%) and 5.5% of men (5.5%) reporting to have had it.
- Non-Hispanic Asian adults had lower rates, compared with Hispanic, non-Hispanic black, or non-Hispanic white adults.
- As family income levels increased, the prevalence of depression decreased
- Approxmately 80% of adults reporting depression claim at least some difficulty with work, home, and social activities as a result of their condition.
The Prevalence of Treatment Resistant Depression
It is widely accepted that recurrent major depressive disorder (MDD) has high morbidity and appreciable, the proportion of pharmaceutically treated depression (PTD) cases that develop into treatment resistant depression (TRD) range from 10% to 35% of cases.
The Burden of Treatment Resistant Depression.
Unsurprisingly, those hospitalized for treatment-resistant depression (TRD) face substantial economic burdens:
- The cost of hospitalization for major depressive disorder was 32% to 49% higher for patients with treatment-resistant depression compared with those with non–treatment-resistant depression.
- Those with treatment-resistant depression had a 25% increased risk for all-cause readmission compared with patients with non–treatment-resistant depression;
- When type of readmission was examined, there was a 31% increased risk for major depressive disorder–related readmission and a 37% increased risk for SI/SA-related readmission within 6 months of discharge.
The clear magnitude of depression afflictions, despite the large number of chemical antidepressants currently available, indicates that there is an enormous need and opportunity for alternative management of depression. The urgency is that much greater due to the fact that antidepressants are limited in their effectiveness on an ever increasing number of individuals.