Many people are unhappy, but at what stage does unhappiness become pathological? And when it does, are people receiving the help they need? These are the two most important questions about depression and a new survey by Landsdowne Market Research has some intriguing answers.
It reveals that despite numerous public information campaigns, depression remains so stigmatised that 83 per cent of people believe that sufferers would not want their condition known in the workplace, while 77 per cent of people believe sufferers are incapable of telling friends or family. Only one in three young people under the age of 24 would, if depressed, confide in a friend - a terrifying result considering the Republic's rising suicide rate.
These bleak findings come from a survey of 1,400 people funded by Pfizer (Ireland) Ltd, a pharmaceutical company concerned that depression is not being properly understood, diagnosed or treated.
Disturbingly, 76 per cent of the general public believe that depressed people are not turning to their GPs for help. This figure of one in four depressed people receiving help coincides precisely with the figures found in international surveys, which show that for every depressed person who is treated, there are another three hidden in the community.
Only 27 per cent of people believe that when approached for help, GPs offer enough support. "We would be bothered if people felt that we were not accessible, approachable and helpful in that respect," comments Dr Michael Boland, director of the post-graduate centre at the Irish College of General Practitioners, which is planning to conduct research into depression.
Dr Edmund O'Flaherty - a GP who sees patients with depression every day of the week - is not surprised to hear that 76 per cent of people do not think that depression sufferers are turning to their GPs.
"Depression is a condition that people do not want to face," he believes. He adds, however, that "many people are afraid to go to the GP because they are intimidated by GPs, who can be quite intimidating. There is room for improvement among GPs. If you cannot talk to your GP or you find yourself in and out the door quickly, move to another doctor."
Dr O'Flaherty believes that people are suffering from depression because of their lifestyles. "This Celtic Tiger is a vicious animal and people's quality of life has disimproved. Young women working while also rearing young children are finding life horrific. Other young women see this and are deciding not to have children. Marriages are collapsing and so women are feeling insecure because they can no longer depend on a partner for life. It's also difficult for young men, who see their positions as fathers and husbands disappearing. For women life is very hard and a man has become a moveable feast."
Pfizer also funded an accompanying survey of GPs, 70 per cent of whom believe that stigma prevents patients from admitting to symptoms of depression. Forty per cent of GPs think that patients do not recognise the symptoms of depression.
Dr Boland, however, suspects that it may be fear of the stigma of a formal diagnosis of depression - rather than an aversion to seeking help from GPs - which is influencing three out of four people to observe that depression sufferers are not turning to GPs for help.
"It's not acceptable to admit that you are depressed. We are all supposed to be happy and beautiful like the people in the ads," he says. "GPs are also concerned that if only one-quarter of people are receiving help, is it the right one-quarter?"
This same question irks Prof Patricia Casey, psychiatrist at the Mater Hospital, Dublin, who has been conducting research into depression. "I disagree with the notion that there is a vast reservoir of untreated depression," she says.
In Casey's view, the psychiatric profession has grossly overestimated the prevalence of depression by mistaking it for unhappiness, with the result that "people suffering for social reasons are being wrongly prescribed anti-depressants".
Dr Boland shares her concern, commenting that the average GP treats 75 cases of depression per year, ultimately referring about four of these cases to hospital. If GPs are only treating one quarter of clinically depressed people, that means that for every 75 seen by the GP, there would be 225 depressed people in the community who should be treated - a conclusion that Dr Boland finds hard to accept.
He believes psychiatrists working in hospitals see only the most severe cases of depression and may thus overestimate the severity of the problem in the community. The popular notion that large numbers of depression sufferers are not being treated has been publicised for many years by AWARE, the depression organisation. Its spokesman, Dr Pat McKeon, a hospital-based psychiatrist, has stated many times in the past that only one in four sufferers of depression is getting help.
However, Dr McKeon has revised that figure to one in three people getting help for depression, explaining that the previous figure was based on US research. AWARE's Irish research shows an improving public awareness of depression, he says.
It's intriguing that, despite an apparent increase in public awareness about depression in recent years, 58 per cent of people still believe they know little or nothing about depression. Dr McKeon refutes this finding, stating that it contradicts AWARE's own research, which involved 65 individuals chosen at random, 100 per cent of whom were able to correctly identify a case history as a case of clinical depression.
The survey also shows that people are extremely confused about what depression actually is. Respondents most commonly describe the key symptom of depression as an "inability to pull oneself together" - an incorrect perception held by 46 per cent of those questioned. Others cite sleep deprivation (21 per cent), drinking too much alcohol (16 per cent), things not going well at home (10 per cent) and unhappiness in the workplace (6 per cent).
WHILE acknowledging social causes, 56 per cent of people still consider depression to be a result of a "chemical imbalance", which is something of a contradiction. GPs who were surveyed have a more accurate view of depression, citing as key symptoms insomnia (62 per cent), fatigue (53 per cent), mood swings (42 per cent) and apathy (28 per cent).
This contradiction between the beliefs of the public and those of doctors, combined with a general "public confusion" does not surprise Casey, who has been conducting her own research into the effectiveness of the tools psychiatrists use to diagnose depression. "Depression means different things to different people," she says.
Dr Boland agrees that without being able to accurately define depression, it is impossible to say who is and who is not depressed. Therefore, we have a situation where people who may or may not be depressed are taking anti-depressants in ever greater numbers. It is intriguing that while the stigma about talking about depression remains, the stigma about taking tablets for depression is lifting: 58 per cent of people surveyed said they would take anti-depressants if prescribed them. Yet young people under the age of 24 are much less likely to accept a prescription for an anti-depressant: 50 per cent of them would try DIY treatment.
Alcohol is the DIY drug of choice, Dr O'Flaherty says, yet alcohol is "Ireland's greatest depressant". He says: "the amount of drink consumed by young women makes my hair stand on end".
For one former depression sufferer, Kieran McCormac of Minds Matter, a consumer advocacy group, "depression is a spiritual crisis. You cannot be depressed when you are involved with life. Drugs are vital in cases of depression, but they are not the whole answer".
AWARE's depression awareness week starts on September 11th. For more details: www.aware.ie