Later this month the BBC will be launching a mental health week including programmes on teenage depression and creative types using Prozac. The current issue of Nature Medicine includes an article proposing that high suicide rates among farmers may be due to them "catching" depression from sheep. Newspaper articles over recent months have covered depression among the Japanese due to work stress, depression among the people of Hong Kong due to overcrowding; depression in Australia because of economic recession, and depression among young people in every country in Europe except, unaccountably, Germany.
Sometimes it seems that the whole world has just got really fed up: that, rather as moods of naughtiness or noisiness sometimes, inexplicably, overtake school classrooms, the globe is being swept by an end-of-millennium fug of existential angst, gloominess and ennui.
Having depression, of course, is not the same thing as being fed up, or moaning about meaninglessness while smoking French cigarettes. It is a clinically diagnosable condition, an illness with recognisable symptoms: broken sleep patterns, changes in appetite, deeply unhappy feelings and suicidal thoughts. Still, there seems an extraordinary amount of it about. An Office of Population Censuses and Surveys report before Christmas suggested that one in seven adults had some form of anxiety or depression. Other figures suggest one in three people will suffer a bout in their lifetime. The question is: is it worse than in the past or is this only an impression? The product or the source of a media fad?
At the Samaritans' campaign launch, one of their financial donors remarked: "It used to be that other thing that was `in', didn't it? What was it? ME?"
The question "Is depression getting worse?" is a tricky one to answer, depression and statistics hardly being natural partners. The illness is widely viewed as an iceberg of which only the tip ever reaches professionals. Calls to the Samaritans have increased by over a third in the last decade - but maybe that is because there are more lines to call, and more awareness of them: no one knows. Suicide rates overall in Britain have fallen over the same period. Suicide rates among young men (15-24) have jumped by a horrifying 71 per cent - but the link between depression and suicide is by no means cut and dried, though thoughts of that escape get many a depressed person through a long night.
One thing that is crystal clear is that there is nothing new about the existence of depression, or about gloom overcoming entire nations at certain periods of history. Professor Roy Porter, author of A Social History of Medicine, points to clinical diagnoses going back to Hippocrates. "Lowness of spirit, agony, anxiety, inability to concentrate, suicide, ennui. All these are quite clearly described as clinical conditions under the term `melancholia'." The notion of urban blues, the alienation of the big city, has apparently existed as long as people have lived in cities.
But in some ages people are definably more depressed than in others. The medical records of Dr Richard Napier, working in Buckinghamshire in the early 17th century, showed that of 2,000 people he treated, half were suffering from depression. "They were out of work, poor, had family problems, husbands beating them up - unbelievably modern-sounding problems," says Professor Porter. "It was a time of civil war, bubonic plague and famine. On top of that there were a lot of preachers going round preaching hellfire and damnation, which tended to make people feel they were doomed."
It could be argued, he said, that there were links between the 17th-century pulpit and the 20th-century media, themselves not uninfluential in making people feel miserable.
The fact that depression is more talked about now, more admitted to, with a soaring profile, is beyond dispute. Forming self-help groups, "providing meeting places with facilities for simple refreshments (eg tea and biscuits)" as Depression Alliance recommends, and sending a brief twice-yearly report to the group's co-ordinator, is not something you could imagine going on among the depressed of any other century.
This is no spontaneous freak of evolution, but the result of a conscious putsch against stiff upper lips and stigma by health professionals. Dr David Baldwin, president of the Depression Alliance, points to the efforts of the awareness-spreading Defeat Depression Campaign, launched three years ago by the Royal Colleges of Psychiatrists and of General Practitioners, and the Government's Health of the Nation initiative, which is aiming to cut the suicide rate by 15 per cent by the turn of the millennium.
The pharmaceutical industry has had its effect too, promoting breakthrough anti-depressants such as Prozac and new drugs which, arriving later this year, will make Prozac look old-hat, apparently. Combined with this, the spread of the self-help culture has reached depression later rather than sooner - so that learning to dread one day at a time, in a group, is only just catching on.
But Dr Baldwin points, too, to evidence that a real increase in incidence of depression underscores the hype. An article last year in the British Journal of Psychiatry showed that a growing number of academic studies were finding first incidences of depression affecting successively younger people. This is borne out, unhappily, by the suicide figures and the fact that British hospital admissions for children under 10 with psychiatric problems have risen by 50 per cent in the last three years. The same article referred to an increase in hospital admissions for depression in the second half of this century over the first - which, though to some extent just more of the iceberg coming out of the water, was felt to be significant.
Why oh why? What is the matter with us all? Back at the Samaritans' advertising launch, at a big cinema in Leicester Square, we looked at newspaper adverts of a sad young man holding a smiley mask to his face, and film of a big red heart set up in lights in Piccadilly Circus on Valentine's day, then ripped in two with an invitation to call the Samaritans underneath. The TV adverts, scheduled for later in the year, offer support through bullying, racist attacks, unwanted pregnancy, bereavement and depression with the slogan "Whatever you're going through, we'll go through it with you."
The effect of the juxtaposition with other TV adverts may be telling: the "be happy, be beautiful, be successful" world of product promotion set beside a parallel - maybe consequent - notion of real people in the real world feeling useless and sad.
Simon Armson, the Samaritans' chief executive, who has worked with the charity for 20 years, says that no one can answer the question why, apart from subjectively, anecdotally. His impression is that in the last two decades the feelings which underlie depression have not altered, but the "precipitating issues" have. "Apart from specific personal crisis, and economic problems, the diminishing role of the extended family has had an effect. Society has closed up so that people feel themselves to be individuals rather than part of a group. It's a loss of an emotional network, people for you to care about and to care about you.
"Religion, in the sense of a belief in a greater being, has always been important and changes in that area also have a bearing. There's a huge increase in the pressures and expectations which society places on individuals, especially the young. And I think the pressure to survive and succeed takes away from the sense of the value of your own being, the importance of caring for your own being."
The Royal College of Psychiatrists survey mentioned earlier pointed also to changing roles between men and women causing confusion and distress. Poverty, unemployment and economic uncertainty are obvious triggers. Other sources point to a decline in religion causing a loss of explicit moral codes, an increased bewilderment as to what we are supposed to be doing and how we are supposed to be.The loopily varied role models offered by movies and popular media increase confusion. The break-up of marriages is an intense cause of pressure on children, and the increasingly fluid and fleeting nature of relationships mean that whereas in the past it was not at all uncommon to have a few brief years of "courting" followed by long marriage, people are spending increasing periods of their life in a state of emotional hiatus.
What makes it worse is that in this country, there is no dramatic problem like a war, a plague or a famine to blame it all on. In fact, this very featurelessness may be part of the syndrome. Professor Porter points out that for civilians, the two world wars of this century have been times when depression "suddenly seemed to disappear. People were galvanised by the war effort. The idea of people defending the country and themselves had a morale-boosting effect. Now the feeling is one of doldrums and aimlessness, a national loss of direction and of purpose."
It's all very depressing. It would be so much easier not to feel stupid about it if we had caught depression from the water, or Chernobyl, which would absolve all feelings of weediness and guilt.
The story in the current Nature Medicine about farmers catching it from farmyard animals is promising in that respect. Research by scientists at the Free University in Berlin has shown a link between depressed farmers and vets and the infectious Borna virus which makes cows, sheep and horses behave weirdly. One good method of cheering yourself up during a depressive bout can now be to search your memory for contact with morose-looking sheep and blame it on them. But without judging the sheep. For depression, as we all now understand, is nothing to be ashamed of.Reuse content