It seems almost impossible to devise a definition which will embrace all aspects of that vague condition known as depression. As generally accepted by clinicians and public alike, depression is estimated to be increasing in incidence world-wide, and to affect about a third of the population of industrialised countries. The picture is vastly complicated by the variety of conditions which it covers.
By strict definition, depression is "the action of pressing down", a formula which does little to enlighten us. A general meaning of interest to health care providers is " the lowering of vital functions or powers." Whereas in common speech we talk of being depressed when we undergo a transitory downturn in mood, there is a more serious aspect to the psychiatrist. It involves severe emotional disturbance, for which external circumstances may or may not be recognised as responsible.
Endogenous depression is a clinical diagnosis where there are recurrent bouts of severe mood lowering without alternating periods of excitation. Reactive depression is an understandable response of a vulnerable personality to adverse incidents of life, and is simple and commonplace, except perhaps in individuals whose component of arrogance is above average. Sheer despondency is something we all experience on rare occasions, and it allows us to empathise with our friends and relatives who complain of being depressed without any pinpointable cause. Between individuals with endogenous and reactive types of depression can be found a continuum of others whose symptoms cannot easily be fitted into one or the other category.
The ever-present dangers of the depressive state are two. First there is the drive to resolve the situation by violent behaviour, even suicide. Then there is the temptation, which may become overwhelming, to seek a remedy in drugs which act upon the central nervous system, whether alcohol or worse things which are now available on all sides if we seek them. This has occurred ever since the human race arrived on earth, but our discovery and modification of chemical agents which will affect our mood - or so we hope - has created an alarming dependence on antidepressants which we must recognise and whose extension we must oppose at all costs.
There are effective methods of combating many forms of minor depression which are based on behaviour modification. One common causal factor is boredom, induced by practising passive occupations, like watching other people do things, and depression so caused is amenable to adopting an active pursuit, putting creativity in place of the consumer spirit. People who keep themselves busy making things or doing useful things are far less liable than the passive consumers to suffer depressive moods. Individuals who practise the creative arts are indeed subject to occasional fits of depression, induced perhaps by a minor frustration, but the fits do not last long. Writers' block is a familiar scourge of those trying hard to complete a work of substance, and it can be distressing. The remedy is to call "walkies" to the dog and go out to brave the elements. Painters and musicians may experience similar effects, which they learn to deal with in much the same way. The failures are those who have recourse to alcohol or other pharmacological aids which in the end prove fatal to creativity and to health.
At a recent conference at the Royal Society of Medicine in London, reported in the Journal of the American Medical Association for December 8, 1999, the Harvard expert, Arthur Kleinman, remarked: "Depression will have an increasing impact on societies and economies everywhere but is still regarded with benign neglect by most people in most countries." It is high time that attitude changed.