Will depression become the leading cause of disability? Experts suggest focusing on patients' social function recovery so they can better return to normal life

The United Nations designates December 3rd of each year as the International Day of Persons with Disabilities, aiming to enhance people's understanding and respect for persons with disabilities and improve their living conditions. In the past, many people believed that the most common disability was physical disability caused by injury, but in fact, depression has become an important cause of disability. The World Health Organization has warned that by 2030, depression will become the world's number one cause of disability.

The State Council has issued a notice on the National Disability Prevention Action Plan (2021-2025), which focuses on strengthening the screening, identification and treatment of major disabling mental illnesses such as depression. However, under the current high prevalence, the recognition rate and treatment rate of depression are very low. The treatment rate of depression in my country is only 8.7%, and only 51.5% of the patients use medication.

On the occasion of the International Day of Persons with Disabilities, Professor Wang Huaning, Director of the Department of Psychosomatic Medicine at the Xijing Hospital of the Air Force Medical University, called on the whole society to pay attention to the diagnosis and treatment of depression patients and the standardized management of the entire course of the disease, to help patients restore their social functions and return to normal life, thereby reducing the disability rate.

Don't ignore the residual symptoms of depression, there is a hidden risk of disability

"What we call the disability of depression is considered from the dimension of social function of patients with depression." Professor Wang Huaning introduced in an interview that the World Health Organization's definition of disability is not limited to physical integrity, but also includes social function dimensions such as physical function and cognitive function. Some patients with depression have social function loss close to a severe disability state, so depression is also regarded as a disabling disease.

Depression is a common mental illness caused by a combination of physiological, psychological, and social factors. Its main manifestations are persistent low mood, loss of interest, and decreased energy. Patients may also experience symptoms such as changes in sleep and appetite, inferiority complex, and suicidal thoughts.

Professor Wang Huaning said that mental illnesses, including depression, are not just psychological problems. The patient's brain is often accompanied by functional abnormalities. "We can think of it as a car. Its hardware looks good, but there are problems with the operation and driving of the car." Therefore, the treatment of depression is mainly organic intervention, mainly through medication.

Clinically, some patients have recovered their social functions after being cured, "but about one-third of patients have poor treatment effects and are unable to recover their social functions for a long time. They are unable to go to school or work normally and are close to functional loss and may already be in the range of disability." Professor Wang Huaning said that the recurrence rate of depression is over 60% in one year and close to 80% in two years. Repeated attacks will also lead to further loss of social functions in patients.

The reason behind this is that the residual symptoms from antidepressant treatment are quietly eroding the social functions of patients. Studies have found that the incidence of residual symptoms after treatment of depression patients is about 30% to 50%. Common residual symptoms include anxiety, cognitive impairment, fatigue, and anhedonia. In this regard, Professor Wang Huaning made a vivid analogy, "It's like a building on fire. It may have multiple fire points. We can put out the fire by finding a few fire points during the fire-fighting process, but there may be other potential fire points hidden. If they are not extinguished, they may catch fire again at the slightest disturbance."

Depression should be treated in a standardized manner with the goal of fully restoring social function

A research data based on the China Mental Health Survey showed that among patients diagnosed with depressive disorders in the past 12 months, only 7.1% of patients with depressive disorders sought treatment in professional mental health institutions, and ultimately only 0.5% of patients received adequate treatment.

Many psychiatric experts emphasize that most patients with depression can be cured as long as they actively receive scientific and standardized treatment. Antidepressant treatment includes drug therapy, psychotherapy and physical therapy, among which drug therapy is still the cornerstone of current antidepressant treatment. Currently, full-course treatment is advocated, including acute, consolidation and maintenance treatment. If the medication is stopped before completing the consolidation treatment course, the risk of relapse will increase sharply. Patients with multiple relapses cannot be completely cured and must learn how to live with this disease.

At present, authoritative domestic and foreign depression diagnosis and treatment guidelines emphasize "obtaining clinical cure, reducing the risk of relapse, improving functional impairment, and improving the quality of life". Antidepressants are the most critical link in the long-term disease management of standardized treatment throughout the entire course of the disease. Whether it is treatment interruption caused by adverse drug reactions or residual symptoms after treatment, they are high-risk factors for the recurrence of depression, and are also "stumbling blocks" for standardized treatment throughout the entire course of the disease, seriously hindering the patient's social function from returning to the pre-disease level.

The monoamine hypothesis recognized by the academic community believes that depression is caused by the decreased activity of the three neurotransmitter channels of serotonin (5-HT), norepinephrine (NE), and dopamine (DA), and that disorders in the three major neurotransmitter systems can lead to different depressive symptoms by affecting different brain regions. Most antidepressants are only effective for the two neurotransmitters 5-HT and NE, but have less intervention on DA, which is often correlated with positive emotions, motivation and pleasure, and has become an important reason for residual symptoms such as cognitive impairment and anhedonia in the treatment of depression. "The realization of multi-mechanism regulation, especially innovative drugs that can act on three neurotransmitter systems at the same time, is currently the research direction we look forward to seeing," said Professor Wang Huaning.

In November 2022, the first domestically produced new type 1 antidepressant drug, Ruoxinlin (torudivenlafaxine hydrochloride sustained-release tablets), was approved for marketing. Preclinical studies have shown that it has a reuptake inhibitory effect on 5-HT, NE, and DA. As an antidepressant with triple reuptake inhibition, clinical research results have confirmed that Ruoxinlin can comprehensively and stably treat depression, significantly improving patients' anxiety, blockade/fatigue symptoms, anhedonia, and cognitive abilities. Its good safety and tolerability are conducive to improving patient compliance with treatment and standardized treatment throughout the course of the disease.

On the occasion of Persons with Disabilities Day, Professor Wang Huaning called on the whole society not to avoid the topic of depression, to understand this disease with a scientific and rational attitude, to help patients better return to life and restore their social functions, thereby reducing the incidence of disability due to depression.