Epidemiological Status

It has been estimated that over a lifetime, the global prevalence of depression is 21.7% for females and 12.7% for males who suffer from depression at some point. The APA has estimated that 5-9% of women and 2-3% of men in the US suffer from depression at any given time.9 A Norwegian study showed that 24% of women suffer major depression at some point in their lives and 13.3% suffer from dysthymia, while 10% of males suffer from major depression at some point and 6% suffer from dysthymia.23 Depression in children and adolescents is a cause of substantial morbidity and mortality in this population, being a common disorder that affects 2% of children and up to 6% of adolescents. Although antidepressants are frequently used in the treatment of this disorder, there has been recent controversy about the efficacy and safety of these medications in this population. This led to the US Food and Drug Administration (FDA) publishing a list of recommendations from the Psychopharmacologic Drugs and Pediatric Advisory Committees in 2004.26 A critical appraisal on the treatment of depression in children and adolescents has been published.26 Some types of depression are familial, indicating that there is inherited vulnerability. Similarly, in studies of families in which members of each generation develop BPAD it has been found that those with the illness have a somewhat different genotype from those who do not become ill. However, the reverse is not true: not all individuals with a purported BPAD genotype will develop the illness. This suggests that additional factors, possibly stresses at home, work, or school or other coping factors, are involved in the onset of the disease.27 In some families, major depression also seems to occur generation after generation, although it can also manifest in individuals who have no family history of depression. It is clear that a combination of genetic, psychological, and environmental factors are involved in the onset of a depressive disorder. However, it is now emerging, particularly in the case of MDD, that changes in brain structures (particularly the hippocampal regions) due to an impairment of neurogenesis may well be associated to some extent with the pathophysiology of depression and the mechanism whereby antidepressants exert their action.13

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