Depression is one of the most prevalent diseases in the worldtoday. Thirty percent of the our adult population suffers withthe illness every year, with many persons receiving either noor inadequate treatment. Psychiatrists know depression as anillness that affects the mind and mood of a sufferer, alteringthat person�s core experience of others and the worldaround them. But now, research convincingly shows that significantmorbidity and mortality are associated with the primary manifestationsof depression beyond that occasioned by the disturbed affect.Patients with major depression have a doubling of mortalityat any age, independent of suicide, smoking, or other risk factorsfor poor health. There is emerging evidence that depressed patientshave a significant loss of cells in the prefrontal cortex, abrain area important in discerning reward versus punishment,in shifting mood from one state to the other, and in exertingcortical restraint on the amygdala fear system through the hypothalamic-pituitary-adrenal(HPA) axis and the sympathetic nervous system. An increase incortisol and norepinephrine secretion represents a highly adversebiochemical environment, a condition that is likely to contributeto many different adverse outcomes, including increased visceralfat, insulin resistance, increased inflammation, enhanced bloodcoagulation, deficient fibrinolysis, decreased bone formation,and increased bone resorption. These changes support the conceptof depression as a systemic disease that may have primary medicalmanifestations. Moreover, depression has adverse effects oncomorbid medical diagnoses as well, such as coronary arterydisease, diabetes, and osteoporosis. Indeed, emerging data haveshown that prospective treatment of depression in patients whohave experienced myocardial infarction increases chances ofa good medical outcome and survival. Thus, detection of depressionin all ill persons is critical, and the pursuit of new and moreeffective treatments for depression will increase psychological,psychiatric, and medical health worldwide.
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