The Haunting Weight of Depression in Israel

The permanent state of war in the Middle East has had a serious effect on the mental health of people in the region. And Israel is no exception. Depression is a frequent mental disorder, which becomes even more frequent when the country is under attack. There is hope that a new drug will contribute to the effective treatment of this wearing mental disorder.

Recently, the FDA approved the drug esketamine, which is particularly effective for those who have been resistant to conventional treatments for depression, or who are at imminent risk of suicide. Like ketamine, a related drug, esketamine, in addition to its anesthetic effects, is a rapid-acting antidepressant, whose medical use was started in 1997. On February 12, 2019, an independent panel of experts recommended that the Food and Drug Administration (FDA) approve the use of esketamine, as long as it is administered in a clinical setting to ensure patient safety.

Esketamine may bring relief to thousands of patients in Israel, where depression is widespread and largely neglected. One of the reasons for this neglect is the feeling of shame associated with mental health issues. Many of those who suffer from depression prefer to think that there is something wrong with them, rather than admit that they suffer from a medical condition, even if it can be treated. It has been estimated that 14 percent of Israelis suffer from clinical depression and this percentage is higher among women than among men. Depression is also much higher among Israeli Arabs.

Depression is a state of low mood which can affect a person’s thoughts, behavior, feelings, and sense of well-being. Its symptoms include sadness, inactivity, difficulty in thinking and concentration, and altered appetite and sleep. Many depressed people have feelings of dejection and hopelessness that may drive them to suicide. Among women, one in seven experiences post-partum depression; about half of them start experiencing symptoms during pregnancy.

Depression can happen at all ages. It can begin during childhood or during the teenage years. As happens also among adults, girls are more likely to experience depression than boys. Clinical depression among the elderly is also common, affecting 6 million Americans ages 65 and older. Among the elderly, depression is frequently confused with the effects of other illnesses. Studies in nursing homes of elderly patients with physical illnesses show that depression substantially increases the risk of dying from those illnesses.

Many sufferers fear also that anti-depressant medications may have serious side effects, and avoid taking them. A poll conducted by Market Watch showed that 80 percent of adults who had suffered from a bout with depression didn’t take any anti-depressants.

Depression has been called a “democratic disease” since it affects people of all social and economic strata. Abraham Lincoln suffered from prolonged periods of depression, which didn’t stop him from becoming one of the most admired presidents in U.S. history. A study of the first 37 U.S. presidents (1776-1974) by Jonathan Davidson, of Duke University Medical Center and colleagues concluded that half of them had been afflicted by mental illness, and that 24 percent met the criteria for depression, including James Madison, John Quincy Adams, Franklin Pierce, and Calvin Coolidge, in addition to Lincoln.

According to the World Health Organization (WHO) estimates, more than 300 million people were affected by depression worldwide in 2015, equivalent to 4.4 percent of the world’s population. Nearly 50 percent of all people diagnosed with depression are also diagnosed with an anxiety disorder. Depression is also a major contributor to suicide, which numbers approximately 800,000 globally annually.

Aside from the effects on health and on people’s well-being, depression exacts a heavy economic toll on individuals, families and on society as a whole. The total economic cost of depression in the U.S. is estimated to be $210 billion annually. That includes decreased productivity, medical expenses, and indirect medical costs

Although there are known, effective treatments for depression, only a small proportion of those affected by it receive such treatments. As depression is on the rise globally, and as there is increased awareness of its importance, the approval of a new drug to treat cases resistant to conventional treatment is a most welcome, and necessary, news.

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Dr. César Chelala is an international public health consultant.