Depression is on the rise

I’m preparing an article on depression and want to say a few words about rising rates of depression. I decided to ask Claude about it. Note its remarks about long-term historical trends, Robert Burton's The Anatomy of Melancholy, and about the “melancholy Dane” (Hamlet). I’ve not attempted to verify any of this, but it looks reasonable to me. It’s certainly a reasonable starting point for a serious look through the archives; here are some posts about depression at New Savanna. I did read large chunks of Burton’s remarkable book while in graduate school.

I’ve appended its remarks below. I’m using my standard convention, setting my words in bold Courier and Claude’s reply in plain Courier.

Version: Claude 3.5 Sonnet

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Is there any evidence that depression has been increasing in the US in the last couple of decades?

Yes, there is evidence of increasing depression rates in the US over recent decades, with several notable trends: Data from major studies shows rising prevalence, particularly among certain groups:

The National Survey on Drug Use and Health found the percentage of adults experiencing a major depressive episode increased from 6.6% in 2005 to 8.4% in 2020, with particularly sharp increases among young adults aged 18-25.

Youth depression has shown especially concerning trends. The CDC reported that the percentage of high school students experiencing persistent feelings of sadness or hopelessness increased from 26% in 2009 to 37% in 2019.

Some demographic patterns in the increases include:

• Higher rates among women compared to men
• Particularly sharp rises among adolescents and young adults
• Greater increases among people with lower incomes and education levels
• Notable increases across racial and ethnic groups, though with some variations

Several potential contributing factors have been identified:

1. Increased social media use and screen time
2. Economic pressures and inequality
3. Changes in sleep patterns and physical activity
4. Decreased in-person social connection
5. Greater awareness and willingness to report symptoms

It’s worth noting that some of the reported increase may also reflect improved recognition and diagnosis of depression, as well as reduced stigma around mental health that leads more people to seek help and report symptoms. However, researchers generally agree there has been a real increase in depression beyond just better detection.

Would you like me to elaborate on any particular aspect of these trends or their potential causes?

Give me some more statistics.

Here are some additional key statistics about depression trends in the US: From national surveys and CDC data:

• From 2009 to 2019, the share of high school students with suicidal thoughts increased from 13.8% to 18.8%
• Among young adults 18-25, major depressive episodes increased from 8.3% in 2011 to 17% in 2021
• Women are about twice as likely as men to be diagnosed with depression (10.5% vs 5.2% as of 2019)
• Around 21% of adults experienced some form of depression in 2020, up from 8.7% before the pandemic
• Looking at specific demographics and regions:
• Rural residents show higher rates (19.8%) compared to urban residents (15.5%)
• Depression rates vary by state, ranging from about 13% in Hawaii to over 25% in West Virginia
• Among adults aged 65+, depression rates increased from 15.8% to 19.2% between 2015 and 2020

Economic correlations:

• Adults with incomes below the poverty level are 2.5 times more likely to have depression
• Approximately 80% of people with depression report some level of functional impairment
• The economic burden of major depressive disorder was estimated at $326 billion in 2018, up from $236 billion in 2010
• Treatment statistics:
• Only about 66% of adults with major depressive disorder receive treatment
• Average delay between onset of symptoms and seeking treatment is 4 years
• Antidepressant use increased 400% between 1988-1994 and 2005-2008

Would you like me to explore any particular aspect of these statistics in more detail?

Can you tell me about long term historical trends?

Historical trends in depression are more challenging to track with certainty, but here’s what research suggests:

Prior to 1900s:

• Depression (then called melancholia) was documented throughout history but prevalence is difficult to determine
• Many cases were likely unrecognized or attributed to other causes
• The condition was often seen as a character weakness or spiritual problem rather than a medical condition

Early-Mid 20th Century:

• The first systematic studies began in the 1920s-1930s
• Each successive generation born after 1915 showed higher rates of depression
• The average age of first onset decreased with each generation
• A landmark study found people born in 1945 were 10 times more likely to suffer depression than those born in 1905

Late 20th Century:

• Major studies in the 1980s and 1990s confirmed this generational pattern
• Research suggested people born between 1945-1954 had depression rates 10 times higher than those born 1895-1904
• The age of first onset continued to decrease
• By the 1990s, the median age of onset had dropped to the mid-20s, compared to the mid-30s in earlier generations

Some researchers have proposed explanations for these long-term trends:

• Industrialization and urbanization leading to changes in social structures
• Declining community ties and extended family networks
• Increasing individualism in Western societies
• Changes in diet and lifestyle
• Rising expectations for personal achievement and happiness

However, it’s important to note some caveats:

• Historical data is less reliable than modern statistics
• Diagnostic criteria and awareness have changed dramatically
• Stigma and reporting biases affect our understanding of historical rates
• Different cultures and time periods understood and described depression differently

Would you like me to elaborate on any of these historical periods or factors? What about writing about melancholia? Was there much interest in melancholia in the 17th century? What about Robert Burton’s Anatomy of Melancholy?

The 17th century saw intense intellectual interest in melancholia, with Burton’s “The Anatomy of Melancholy” (1621) being perhaps the most comprehensive work on the subject. It’s a fascinating period in the history of mental illness.

Burton’s work is remarkable for several reasons:

• It’s encyclopedic in scope, running over 1000 pages and drawing on countless classical and contemporary sources
• He approaches melancholy as both a universal human condition and a specific illness
• He combines medical, philosophical, literary, and religious perspectives
• Burton himself suffered from melancholy and wrote partly as self-therapy, famously stating “I write of melancholy by being busy to avoid melancholy”

Beyond Burton, the 17th century saw melancholia as a major cultural and medical preoccupation:

• It was seen as particularly affecting scholars and creative people (the “scholar’s malady”)
• The theory of the four humors was still dominant, with melancholy linked to black bile
• It was associated with both genius and madness
• Religious melancholy was a major concern, especially among Puritans
• Many saw it as a fashionable affliction of the educated classes

Major themes in 17th century writing about melancholia included:

• The relationship between body and soul
• The role of imagination and reason
• The influence of the stars and planets
• Diet and lifestyle as causes and cures
• The connection between melancholy and creative genius
• Religious despair and spiritual crisis

The period also saw new treatments being proposed:

• Traditional remedies like bloodletting and purging
• Dietary recommendations
• Exercise and fresh air
• Music therapy
• Social interaction
• Travel
• Various herbal remedies

Would you like me to expand on any particular aspect of 17th century views on melancholia?

What about “the melancholy Dane”?

Ah, Shakespeare’s Hamlet - the quintessential melancholic character in English literature! The portrayal of Hamlet’s melancholy is fascinating because it reflects both Elizabethan/Jacobean understandings of melancholia and creates an enduringly complex psychological portrait.

In Hamlet (written around 1600-1601), melancholy manifests in several ways:

• His “antic disposition” - which may be partly feigned but stems from genuine disturbance
• His philosophical ruminations on death and existence (“To be or not to be”)
• His inaction and paralysis of will
• His cynical wit and bitter wordplay
• His social withdrawal and contempt for normal pleasures

The play engages with contemporary theories about melancholy:

• The idea that it could be both a disease and a sophisticated temperament
• The link between melancholy and intellectual depth
• The connection between melancholy and social/political criticism
• The relationship between melancholy and madness (real or feigned)
• The question of whether melancholy comes from physical or psychological causes

Shakespeare presents multiple perspectives on Hamlet’s condition:

• Claudius sees it as dangerous political opposition masked as illness
• Polonius thinks it’s love-melancholy caused by Ophelia
• Gertrude attributes it to his father’s death
• Hamlet himself is ambiguous about whether his melancholy is natural grief or something more pathological

This ambiguity about the nature and cause of Hamlet’s melancholy is part of what makes the character so compelling - we’re never quite sure how much is genuine illness, how much is grief, how much is philosophical disposition, and how much is strategic performance.

The phrase “melancholy Dane” has become almost proverbial, but it’s worth noting that Shakespeare was drawing on and transforming existing traditions about melancholy, including:

• The medieval concept of acedia (spiritual sloth)
• The Renaissance idea of the melancholic genius
• The revenge tragedy tradition
• Contemporary medical theories about humors and mental states

Would you like me to elaborate on any of these aspects of Hamlet’s melancholy?