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Robert Leahy, Ph.D.

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The Cost of Depression

Posted: 10/30/10 03:31 AM ET

Depression is widespread and it is getting worse. Nineteen percent of Americans will suffer from depression at some time during their lives. Sadly, depression hits the young and old alike. Fifty percent of children and adolescents and 20 percent of adults report some symptoms of depression. Even though many kids don't "qualify" for the clinical diagnosis of depression, they have some of the problems that "truly depressed" people have--such as sadness, self-criticism, and the inability to enjoy their lives.

Many of these depressed kids eventually become depressed adults. And, it's getting worse in recent decades (Kessler and Walters, 1998; Ronald C. Kessler, Avenevoli, & Ries Merikangas, 2001). Kids born after 1960 were significantly more likely to suffer from depression in childhood or adolescence than kids born before 1960 (Klearman, G.L., Weissman,M.M.(1989)). Depression is on the rise--and the costs are escalating.

Depression has human costs that we all know of: sadness, sense of isolation, feeling like a burden, inability to enjoy life, and--for 35,000 people every year--suicide (Joiner, 2010). In fact, people who are depressed are 30 times more likely to kill themselves than people who are not depressed (Hawton, 1992). Depressed individuals are five times more likely to abuse drugs. These costs in the quality of life are enough to make us all concerned about depression. They are the human costs which are widespread and touch almost every family in America.

But there are also economic costs that are also significant--indeed, alarming.

Depression is the leading cause of medical disability for people aged 14 to 44 (Stewart, Ricci, Chee, Hahn, & Morganstein, 2003). Depressed people lose 5.6 hours of productive work every week when they are depressed (Stewart, 2003). Eighty percent of depressed people are impaired in their daily functioning (Pratt & Brody, 2008). Fifty percent of the loss of work productivity is due to absenteeism and short-term disability (R. C. Kessler, et al., 1999). In any 30 day period, depressed workers have 1.5 to 3.2 more short-term disability days (Druss, Schlesinger, & Allen, 2001).

People with symptoms of depression are 2.17 times more likely to take sick days (Adler, et al., 2006; Greener & Guest, 2007). And when they are at work their productivity is impaired--less ability to concentrate, lower efficiency, and less ability to organize work. In fact, absenteeism and work performance are directly related to how severe the depression is--the more severe the depression, the worse the outcome. In one study the costs of absenteeism were directly related to actually taking antidepressant medication (Birnbaum, et al., 2010; Dewa, Hoch, Lin, Paterson, & Goering, 2003). Those who took the prescribed medication had a 20 percent lower cost of absenteeism. Depressed people are seven times more likely to be unemployed (Lerner, et al., 2004).

In one of the largest studies of its nature ("The long-term effects of psychological problems during childhood"), children were followed for 40 years to determine the effects of illness and psychological problems on their life chances (Smith & Smith, 2010). Children or adults who suffer from depression have lower incomes, lower educational attainment and fewer days working each year. In fact, these psychological problems lead to seven fewer weeks of work per year, a loss of 20 percent in potential income, and a lifetime loss for each family who has a depressed family member of $300,000 (Smith & Smith, 2010).

People who suffer from depression end up with six-tenths of a year less schooling, an 11 percent decrease in the probability of getting married, and a loss (on average) of $10,400 per year in income by age 50 (Smith & Smith, 2010). In fact, there is a 35 percent decrease in lifetime income--due to depression. The cost for the total group--over one's lifetime--is estimated at 2.1 trillion dollars (Smith & Smith, 2010). And this does not include the increased cost of medical care that all of us must assume. Depression is a lifelong vulnerability for millions of people. And it's a national economic crisis.

The cost of depression (lost productivity and increased medical expenses) is $83 billion each year which exceeds the costs of the war in Afghanistan (Greenberg, et al., 2003). And depression is not a "limited engagement" with a fixed endpoint. These costs reoccur each year, every year, for the foreseeable future. Depression is an ongoing war that we may only recently recognize is a difficult one--but a potentially winnable war.

In the United Kingdom the National Health Service (NHS) has developed the largest mental health intervention program in history. The Improving Access to Psychological Treatments (IAPT) initiative mandates access to effective treatments for depression and other psychological problems. The argument behind this national initiative is largely economic--depressed people are less likely to work, have more disability days, and are less likely to be able to pay taxes. Simply from a practical point of view, effective treatment for depression makes economic sense. It's a good investment. If you effectively treat depression, people are more likely to work, require less disability coverage and--as cynical as it may sound--more likely to pay taxes. Treating depression pays. It's smart policy--and the right thing to do.

We may not be able to effectively overcome depression for everyone. Even though there are effective treatments for depression--such as medication or cognitive behavioral therapy--depressed people often wait over 10 years on average to seek treatment. This may sound depressing. But there is hope. If more people seek treatment earlier--and get effective treatment--the human cost and the economic costs can be reversed. It is hard to imagine what could be a higher priority if we care about the welfare of our people.

Robert L. Leahy, Ph.D.
American Institute for Cognitive Therapy
Author: "Beat the Blues Before they Beat You"

References

Adler, D. A., McLaughlin, T. J., Rogers, W. H., Chang, H., Lapitsky, L., & Lerner, D. (2006). Job performance deficits due to depression. American Journal of Psychiatry, 163, 1569-1576.
Birnbaum, H. G., Kessler, R. C., Kelley, D., Ben-Hamadi, R., Joish, V. N., & Greenberg, P. E. (2010). Employer burden of mild, moderate, and severe major depressive disorder: Mental health services utilization and costs, and work performance. Depression and Anxiety, 27(1), 78-89.

Dewa, C. S., Hoch, J. S., Lin, E., Paterson, M., & Goering, P. (2003). Pattern of antidepressant use and duration of depression-related absence from work. British Journal of Psychiatry, 183, 507-513.

Druss, B. G., Schlesinger, M., & Allen, H. M. (2001). Depressive symptoms, satisfaction, with health care, and 2-year work outcomes in an employed population. American Journal of Psychiatry, 158, 731-734.

Greenberg, P. E., Kessler, R. C., Birnbaum, H. G., Leong, S. A., Lowe, S. W., Berglund, P. A., et al. (2003). The economic burden of depression in the United States: How did it change between 1990 and 2000? Journal of Clinical Psychiatry, 64, 1465-1475.

Greener, M. J., & Guest, J. F. (2007). Do antidepressants reduce the burden imposed by depression on employers? CNS Drugs, 19, 253-264.

Hawton, K. (1992). Suicide and attempted suicide. Handbook of affective disorders. E. S. Paykel. New York, Guilford Press: 635-650
Joiner, Thomas Myths about suicide. Cambridge, MA, US: Harvard University Press. (2010). 288 pp.

Kessler, R. C., Avenevoli, S., & Ries Merikangas, K. (2001). Mood disorders in children and adolescents: An epidemiologic perspective. Biological Psychiatry, 49(12), 1002-1014.
Kessler, R. C., Barber, C., Birnbaum, H. G., Frank, R. G., Greenberg, P. E., Rose, R. M., et al. (1999). Depression in the workplace: Effects on short-term disability. Health Affairs, 18, 163-171.

Kessler, Ronald C. and E. E. Walters, "Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the National Comorbidity Survey," Depression and Anxiety 7 (1998): 3

Klearman, G.L.,&Weissman,M.M.(1989).Increasingratesofdepression. Journal of the AmericanMedicalAssociation,261(15),2229e2235

Lerner, D., Adler, D. A., Chang, H., Lapitsky, L., Hood, M. Y., Perissinotto, C., et al. (2004). Unemployment, job retention, and productivity loss among employees with depression. Psychiatric Services, 55(12), 1371-1378.

Pratt, L. A., & Brody, D. J. (2008). Depression in the United States household population, 2005-2006: NCHS Data Brief Number 7.

Smith, J. P., & Smith, G. C. (2010). Long-term economic costs of psychological problems during childhood. Social Science & Medicine, 71, 110-115.

Stewart, W. F., Ricci, J. A., Chee, E., Hahn, S. R., & Morganstein, D. (2003). Cost of lost productive work time among US workers with depression. Journal of the American Medical Association, 289, 3135-3144.


 
 
 

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Depression is widespread and it is getting worse. Nineteen percent of Americans will suffer from depression at some time during their lives. Sadly, depression hits the young and old alike. Fifty perc...
Depression is widespread and it is getting worse. Nineteen percent of Americans will suffer from depression at some time during their lives. Sadly, depression hits the young and old alike. Fifty perc...
 
 
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07:10 PM on 11/01/2010
I have been counseling two mental health nurse practitioners. One of whom said, "Everything just keeps getting worse" While the other echoed, "The world keeps getting worse." I asked the second if she had ever told any of her patients that. She said, "No." I knew she was lying. I then asked her if she thought the world could be experiencing a mass psychosis. When she answered no to that and given her concerns about life I suggested perhaps she was experiencing a mild psychosis about the legitimacy her own depression. Because given the current reality we all share if anyone is not depressed there certainly must be something extremely wrong with them. I can also say the irony of just validating her own feelings of enui and pathos appeared to help her tremendously by the end of the session.
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Lahonda
Bynocent Instander
09:50 PM on 10/31/2010
Depression can be caused by chronic inflammation - UCal SD:

http://timesofindia.indiatimes.com/life-style/health-fitness/health/Depression-linked-to-chronic-brain-inflammation/articleshow/6786769.cms

Think of it being much akin to having a low-level flu, without the cough, temperature and sniffles.

Less medication and therapy if we can control any instance of chronic inflammation.
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I3edlam
Pick your foma.
10:38 AM on 10/31/2010
Sounds like a great advertisement. Sad that one has to invoke economic incentives to initiate some simulacrum of compassion. Simulated desire and simulated compassion. It doesn't matter whats inside. Is there any wonder why people become depressed? Life lived as indicated above is an act without meaning.

It's always easy to galvanize an optimist with the economy carrot. Just look at all those happy go lucky blissfully ignorant republicans chomping at the bit to "free the economy" from the government. Their happiness = numbers in wall street.

But that's the way life is. No one get's out alive, and we all decompensate on some level. We all die. Some people get affected by it. I think it's completely understandable. The problem with "curing" some people, is that one is basically telling them their experience is wrong. Can you imagine if I walked up to you and basically said, "Look me and everyone else have this common understanding of what is right in the world, and you don't" It just feeds the disease. This too happens from time to time.
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bnation
Not all who wander are lost. J.R.R. Tolkien
07:38 AM on 10/31/2010
Excellent article! I appreciate the author citing the sources. Here is a link to a brief article on clinical depression which shows the differences in the brain scans between depressed and non-depressed:

http://www.associatedcontent.com/article/5841186/what_is_clinical_depression.html?cat=5
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rtx47
11:40 PM on 10/30/2010
Why is depression more common today that it was a generation ago?
Is the diagnosis of depression made more often?
Is it we have more drugs to treat depression?
Is the epidemic of depression a reflection and result of failing family and societal support systems?
Are we treating depression as a symptom of a larger underlying problem; that we are ignoring?
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chaapai
just an earthbound misfit, I
09:47 PM on 10/31/2010
isnt it just a lack of our overall health? From the toxic substances in our food to the pollution in our air and water. We worry more, sleep less, and chase the almighty dollar instead of our own happiness. We treat others less compassionately. We are less social and friendly. I think it all just adds up till it starts to take its toll on our body and also on our society.
nothingchanges
too soon old, too late smart
11:09 PM on 10/30/2010
"If more people seek treatment earlier--and get effective treatment--the human cost and the economic costs can be reversed. It is hard to imagine what could be a higher priority if we care about the welfare of our people"

The operative phrase is, If we care about the welfare of our people. If that is our highest priority then why such heated, hate filled rhetoric about health care reform (both for and against)?

If depressed people make so much less ($10,400 a year less) then non depressed people, how can they afford treatment in a society based on capitalism?

How much profit (in billions of dollars, and percentages) do drug companies make from anti-depressants?

What's the average salary of the health care professional that treats depression? How does that compare to the income of the average patient?

Is depression genetic, or does the everyday stress of fighting to make a living in an increasingly cut throat culture and competing for a place in the ever shrinking labor pool add to the problem? Why is the problem growing and what's the largest contributing factor?

Personally I find it depressing that the first question I have to ask about almost any topic in the news and on the blogs anymore is......... where does the money trail lead?

If there were no higher priority in America, then the welfare of our people. I wouldn't have to ask myself that question, everyday, over and over again.
11:21 PM on 10/30/2010
Indeed, our mental healthcare system is woefully inadequate to treat a large segment of our population and there seems to be very little concern for the welfare of our people. As long is profit is a part of healthcare, our system will remain woefully inadequate.
07:59 PM on 11/01/2010
This short post above says volumes more about the true causes of depression than the libraries of books that have been written about the subject.Our local mental health facility spends $60,000 a month to have the poor and depressed warehoused there in the most demeaning of an environment. Virtually none of the patients there can afford to own their own home much less live in splendor or opulence in their own apartments which they generally can not wait to escape back to after they become "well". Meanwhile the so called "sane" and untreated spend more on one bullet to kill or maim someone half way around the world than is spent on a daily allotment of food for these same "depressed' and mentally ill people I am referring to. The cost of shock treatments for sadness runs as much as $10,000 a session with temporary success at best. God forbid that we should send them to the Caribbean to spend that money with possibly greater success. Somewhat related to this is what a psychologist by the name of R.D. Lang once stated which was something to the effect that "the normals" of humanity who have killed billions of their fellow man in this last century...have lost all right to be called sane. Or as a contemporary poet said not too long ago, "They locked up a man who wanted to rule the world. The fools...they locked up the wrong man."
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Donald Simon
11:05 PM on 10/30/2010
This article says that 19% of adults will suffer major depression at some time in their lives must be wong. I would think it is closer to 50%. Studies have shown that untreated major depression causes the brain to shrink was a cascade of problems that follow. I heard last week that the Federal government spends 500 million per year on brain research. Yet we spend almost one billion per day on two wars. May we awaken.
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I3edlam
Pick your foma.
10:40 AM on 10/31/2010
Really, does the brain shrink that much? That's terrible.
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Lahonda
Bynocent Instander
09:52 PM on 10/31/2010
Depression can be caused by chronic inflammation - UCal SD:

http://tim­esofindia.­indiatimes­.com/life-­style/heal­th-fitness­/health/De­pression-l­inked-to-c­hronic-bra­in-inflamm­ation/arti­cleshow/67­86769.cms
ThatsTheTheWayItIs
religion, ideology, partisanship are delusional
09:49 PM on 10/30/2010
I assume you are arguing that prescription drugs save money; they do not. Certainly statins do not. They cost billions and do not reduce deaths or hospitalization. I will bet SSRIs also do not save money, and I assume that is what is being sold here.

If you review studies, in many cases only those from the US find drugs and tests to be effective, the rest of the world does not. For example, only US studies find that mammograms reduce breast cancer deaths, those outside US do not. It is very suspicious when the most for-profit system finds profitable treatments effective, while others do not.

I worked in medical imaging for five years, went to RSNA, consulted with radiologists, from US, EU, Japan. That is why I trust reports from US medical industry like I do those from AEI. Both are trade groups, working to increase profits.

http://www.annals.org/content/153/6/JC3-4.citation
Statins do not reduce mortality in patients with heart failure

http://www.medpagetoday.com/Cardiology/Prevention/20948
Should Healthy People Take Statins? New Studies Say No
Reanalysis of a landmark cholesterol-lowering trial of people typically considered at low risk for heart attacks indicated that the results are flawed -- and do not support the primary-prevention benefits that made headlines.
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indc
08:38 PM on 10/30/2010
There are 100K troops in Afghanistan, each costing about 1 million dollars each per year, plus there are contractors, plus there is the State Department, plus there is USAID, plus there are drone pilots in NE and NO CA and wherever else, plus there is CIA, plus there is NSA, plus there are huge residual cost for care of the injured and pensions, and it goes on. The sum is probably closer to half a trillion a year.

It is hard to trust a therapist who out of touch with reality or cannot add... you might want to consult Stiglitz's book about the cost of the wars...
ThatsTheTheWayItIs
religion, ideology, partisanship are delusional
09:53 PM on 10/30/2010
The war in Afghanistan is now costing $70B a year, 10% of our total defense budget. We have 90,000 troops in Japan and Germany, they cost more than Afghanistan.

Three times as many died in Iraq, likewise were injured. 50,000 died in Vietnam, 8x both of them combined. Afghanistan is a minor police action, not costly in life or money.

The last 30 years since we ended the draft are the most peaceful in US history, look it up.
02:21 PM on 11/08/2010
Yes, TTTWIT, but isn't it wonderful to think of all the jobs and meaningful work never ending war provides to the human race by way of making weapons to destroy so many of our fellow kind and one empire of cards after another so that we can provide ourselves even more work building them up all over again to destroy all over again ad infinitum? NOT! Otherwise what ever would the devil do with so many idle hands who had nothing to do but enjoy the natural abundance the Earth could provide all of us? Or in other words what the world presently spends on war every two weeks during this most peaceful time in US history could provide food, clothing, shelter, and luxuries for every man woman and child. Look it up.

Then again just take a look at all the work that is going to be provided by the birth of these victims of angelic innocence through no fault of their own by way of using the weapon of mass destruction known as depleted uranium:

http://www.google.com/images?hl=en&client=firefox&hs=tds&rls=com.yahoo:en-US:official&q=depleted+uranium+baby+images&um=1&ie=UTF-8&source=univ&ei=00zYTNusKoH78AaAz_CUDA&sa=X&oi=image_result_group&ct=title&resnum=1&ved=0CCsQsAQwAA&biw=1280&bih=620
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edgarcaycedoc
07:17 PM on 10/30/2010
As a person who suffers from PTSD, I know how debilitating depression can be. I have tried on three different occasions to commit suicide (obviously did not really want to succeed, or I would have). But with some counseling and lots of medication, I am more functional. The urge to destroy myself remains, but not as bad as it was during my earlier years.
11:23 PM on 10/30/2010
Do take care of yourself. I hope you have the support you need. Staying with a regimen requires a lot of discipline and discipline is difficult when you feel vulnerable. All the best to you.
09:50 AM on 10/31/2010
I'm sorry to hear you've been having this problem - I sincerely hope you improve even more soon.

No matter how bad things get - just promise yourself to hang on for one more day.
04:37 PM on 10/30/2010
I consider myself lucky to have been analyzed by a talented Jungian therapist 30 years ago. Instead of focusing on eradicating my depression through medications and happy thoughts, I was guided into accepting and appreciating the validity of my depressive thoughts and feelings, while, at the same time learning to listen to other, countervailing voices present in my unconscious. It's a pity that the Jungians' subtle, yet profound understanding of the complex interplay of opposing forces in the human personality continues to be much undervalued and maligned.
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Changeizgood
08:43 AM on 11/23/2010
i suffered from it also when they purged my vote in 2000, for no apparent reason. I wasn't on the list.

It didn't compute in "my supercomputer" and short circuited any reason to be connected to the country. I was angry bitter and vengeful. Cursed Bush to the blue blazes for his cabal of crooks for 8 years. The only cure I had available was making a difference in changing through helping candidates that were "GOOD FOR THE PEOPLE."

I was better during the Kerry campaign, that just gave me a lift out.
I got even more better when Dems were put in control in 2006, even though the filabuster stopped most of their reversals of Bush tax cuts to the rich.
In 2008, I was cured, and now I know how to do what has to be done, and advise others on how to do their due dilegience and and research for truth before voting.

I used to have IQ of 145, now it's about 128, but I'm getting better with tone to clear the "7 chakras" in my body and accept the things i cannot change, learning the difference.
youtube search your 7 chakras, and when nobody is around, Ommmmmmmm your self to health.
03:43 PM on 10/30/2010
jEvery drug to treat depression has side effects that can be just as bad or worse than the depression itself. Beware of drugs. They are useful but they also get you into a hole you may never get out of.
11:24 PM on 10/30/2010
I strongly believe that drugs, by themselves, are inadequate to treat depression without accompanying talk therapy. There is a tendency to dope people up and hope they'll go away.
01:53 PM on 11/01/2010
Which is why a reputable doctor will carefully monitor his/her patient when using a new medication or changing dosage


I don't know here my wife would be without her medication: She's no longer suicidal, can leave the house for hours at a time, etc.

In her case, other than a dry-mouth sensation, medication has been an unmitigated cause for celebration
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Changeizgood
08:50 AM on 11/23/2010
jDid she stay in the bedroom in a corner of the bed. I had to run my house from there for two years. It was the only thing stable in my life at the time. I had doubts about those who said they cared, but usually only came around for a handout, and then left.

Recognizing things around you going on, is a reality check and when you find those who are really just after something, anything from you. Get away if they don't give some sort of happiness back. Whether from conversation or spending of time.
My doctor told me after raising nine children, of whom four are ungrateful and sometimes disrespectful.
Treat them like a satelite around your orbit.
"Sorta like the ten foot pole' lesson. You are the center, they are the satelites, you can turn them off anytime, but not listening to them if they are a downer, abusive, or just plain energy drainers of wowsy woozers.
If necessary, treat them like an "outer galaxy" and don't answer the phone.
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Lisa Frederiksen
Author, Speaker, Consultant-BreakingTheCycles.com
01:08 PM on 10/30/2010
Another concern is that mental illness, such as depression (or PTSD, bipolar, etc.), is one of the key risk factors contributing to a person’s developing alcoholism or a drug addiction, and that addiction/alcoholism always begins with alcohol or drug abuse. Often the substance abuse starts with a person misusing alcohol or drugs in order to feel better — in essence, to self-medicate the mental illness. Repeated substance abuse, however, causes chemical and structural changes in the brain as does the mental health illnesses -- making it very important to treat both in order to treat either. (Thirty-seven percent of alcohol abusers and fifty-three percent of drug abusers also have at least one serious mental illness, such as depression, PTSD, bipolar, anxiety, schizophrenia.)
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PeterMelzer
12:25 PM on 10/30/2010
Our mind is sensitive to the seasonal changes in daylight. The prevalence of depression is greater in Northern countries with short daylight hours in the winter. Besides medication, light therapies are known to provide effective treatment there. Our brain is a giant self-medicating gland.

Read more here:
http://brainmindinst.blogspot.com/2008/06/brain-giant-self-medicating-gland.html
11:25 PM on 10/30/2010
Absolutely. I suffer from SAD - Seasonal Affective Disorder and am very careful to expose myself to light in the darker months.
11:35 AM on 10/30/2010
For depression take two quarts of juiced organic vegetables a day for one week, then one quart every other day. Stop intake of all meat and dairy products and drink tea with lemon. Exercise outside in the sun one full our a day, particularly brisk walking. Don't hunt, but fish. Find the most secluded fishing areas and begin fishing with a close friend. Buy a boat, if you can affor it, or fish the banks or go wading. You should be out of your depression in about a month.
01:30 PM on 10/30/2010
Hmmm........ facile and glib.
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HLaura444
12:52 PM on 11/03/2010
Maybe facile, but way more effective and long lasting than taking a pill. Nobody should be prescribed antidepressants without accompanying lifestyle changes, but unfortunately our society has been conditioned to look for an easy fix.
01:36 PM on 10/30/2010
A few grams of seconal with a vodka chaser and a person can be out of their depression in less than a month.