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Major depressive disorder (MDD) is often a chronic and recurring illness. Depressive episodes can have a profound impact on multiple aspects of a patient’s life, including physical health, quality of life, and the ability to effectively function at school, work, or with family.^1,2 One survey of US adults indicated that 19.2% of adults experienced the symptoms of at least one episode of major depression during their lifetime, yet 42.3% of patients with symptoms of major depression in the last 12 months did not receive any treatment for their emotional health.³

Untreated Depressive Episodes Worsen Functional Outcomes Over Time

A diagnosis of depression can have a negative impact not only on the patient, but also on their family, social circle, and employer, as well as, on the overall healthcare and economic system.² Patients with depression tend to have multiple comorbidities, and it is estimated that the direct and indirect costs of depression totaled $210 billion in 2010 ($236 billion in year 2020 values) and have increased to $326 billion in 2018 (year 2020 values).⁴ Societal costs of depression include reduced educational achievement, poorer financial success, higher number of days out of work, and increased risk of job loss.⁵

Many patients with MDD are either untreated or if they do receive treatment, they often do not regain their baseline level of functioning.⁶ For many patients, full functional recovery will lag behind an improvement in symptoms of depression, even in cases where they may be identified as being in symptomatic remission by definition.⁶ In addition, data suggests that the potential for achieving functional improvement decreases as the duration of depressive symptoms increases and treatment failures occur.^6,7

Brain imaging research has noted that untreated MDD is associated with damage to the brain, as shown by a loss of volume in various areas, including the hippocampus.⁸ This damage may worsen progressively with continuing depressive episodes.⁸ Therefore, failure to treat a patient’s depressive episodes quickly and effectively may have a lasting effect on brain structures and function, which could impair functional outcomes and recovery in the future.

Early Detection and Management of Depression May Prevent Additional Declines in Functional Outcomes

Evidence suggests the greatest potential for achieving full functional recovery for patients with depression is having both early diagnosis and early optimized treatment.⁶ Several studies demonstrated that early identification and treatment of depression, using standardized questionnaires given by health care providers, can improve the negative aspects of the disorder.^2,9,10

Early diagnosis, targeted treatment goals, and early evaluation of treatment outcomes are critical to providing optimized patient-centered treatment, and preventing the long term functional impacts of untreated or undertreated symptoms.⁶ Health care providers across the health care team are uniquely positioned to identify symptoms and optimize therapy early, which can substantially reduce the significant morbidity, mortality, and functional impairment associated with depression, and have a positive impact on both the quantity and quality of life.⁶

References:
1.    Fact sheet on depression. World Health Organization. September 13, 2021. Accessed September 7, 2022. https://www.who.int/news-room/fact-sheets/detail/depression
2.    Halfin A. Depression: the benefits of early and appropriate treatment. Am J Manag Care. 2007;13(4 Suppl):S92-S97.
3.    Kessler RC, Birnbaum H, Bromet E, Hwang I, Sampson N, Shahly V. Age differences in major depression: results from the national comorbidity survey replication (NCS-R). Psychol Med. 2010;40(2):225-237. doi:10.1017/S0033291709990213
4.    Greenberg PE, Fournier AA, Sisitsky T, et al. The economic burden of adults with major depressive disorder in the United States (2010 and 2018). Pharmacoeconomics. 2021;39(6):653-665. doi:10.1007/s40273-021-01019-4
5.    Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119-138. doi:10.1146/annurev-publhealth-031912-114409
6.    Habert J, Katzman MA, Oluboka OJ, et al. Functional recovery in major depressive disorder: focus on early optimized treatment. Prim Care Companion CNS Disord. 2016;18(5):10.4088/PCC.15r01926. doi:10.4088/PCC.15r01926
7.    van der Voort TY, Seldenrijk A, van Meijel B, et al. Functional versus syndromal recovery in patients with major depressive disorder and bipolar disorder. J Clin Psychiatry. 2015;76(6):e809-e814. doi:10.4088/JCP.14m09548
8.    Oluboka OJ, Katzman MA, Habert J, et al. Functional recovery in major depressive disorder: providing early optimal treatment for the individual patient. Int J Neuropsychopharmacol. 2018;21(2):128-144. doi:10.1093/ijnp/pyx081
9.    Picardi A, Lega I, Tarsitani L, et al. A randomised controlled trial of the effectiveness of a program for early detection and treatment of depression in primary care. J Affect Disord. 2016;198:96–101. doi:10.1016/j.jad.2016.03.025
10.    Rost K, Smith JL, Dickinson M. The effect of improving primary care depression management on employee absenteeism and productivity. A randomized trial. Med Care. 2004;42(12):1202–1210. doi: 10.1097/00005650-200412000-00007