When we talk about the financial sustainability of Canada’s health care system, we tend to focus on the needs of an aging population, the increasing costs of prescription drugs, and the impact of new high-priced technologies. But there is another, less discussed, factor that will have an important impact on health care in the future: the financial and human cost of mental illness, depression in particular.

Mental health is a greater disease burden on our health care system than all cancers combined. Depression is the fastest growing source of employee disability in the labour force. It has already surpassed heart disease as the leading cause of lost work year around the world.

In Canada, we lose 35 million workdays every year to the disease, and many people who remain in the workplace are less productive because they are battling depression. The cost to the Canadian economy for mental illness in general and for depression-related issues, in particular in terms of health care, child abuse and neglect, addictions, criminal justice services, lost income and productivity is estimated to be over $50 billion a year.

The human costs are just as catastrophic. About one in six people will experience depression in their lifetime. It affects men and women of all ages, but it often occurs in people in their prime working years. Only a third of cases of depression are effectively diagnosed and treated, in part because depression lies in the long shadow of the stigma attached to mental illness. Ten to fifteen per cent of people who are hospitalized for depression will eventually commit suicide.

Depression also plays an important role in other serious illnesses. There are strong links between depression and heart disease, Parkinson’s disease and diabetes, and depression often co-exists with other psychiatric illnesses such as addictions, anxiety and post-traumatic stress disorder.

While there are many factors that lead to depression, genetics and stressors are important contributors. Researchers like to say that genetics load the gun, while stressors pull the trigger. For those with a genetic predisposition to depression, many stressors can come from today’s high-pressure workplace with its instant-on technologies and blurred line between work and home.

Like other industrialized countries, Canada has moved from a resource-based economy where physical strength determined success in the workplace to a brain-based economy where mental well-being and intelligence determine success in the global marketplace. In our brain-based economy, a brain-based illness like depression has a particularly devastating effect.

Yet in spite of the economic and human impact of depression, Canada spends less than five per cent of its health research budget on mental health research. As we look ahead to the health care system of the future, we will need to invest more in research, diagnosis and treatment to begin to change the outcomes for patients with depression and to lessen the impact on our economy.

At the new Depression Research Centre at The Royal, we are beginning to see the positive results from an intense dedicated focus on depression. As a specialized care facility that treats the most resistant and complex cases of depression, the Centre is using research-informed clinical practice to accurately diagnose and treat depression more quickly and effectively. Studies at the Centre have already shown double the remission rates in six weeks in patients with treatment resistant depression.

By using imaging technologies such magnetic resonance spectroscopy, we are able to see how the brain functions in depression and to develop reliable brain-based diagnostic markers to do more individualized diagnosis and to recommend the most effective treatments for a specific patient.

Research is also guiding new treatment plans with prescription drugs. Instead of the long and painful method of trying first one, then another drug for depression, physicians are now using more than one drug at once and changing treatment often to find the most effective medication for each person.

The Centre is also looking at the impact of treating depression where it co-exists with other illnesses. Patients with cardiac disease, Parkinson’s disease or substance abuse will frequently also have depression – for example, half of the patients with Parkinson’s will suffer from depression, and in cardiac disease, patients whose co-existing depression is untreated present up to four times increased rate of mortality.

Usually patients receive treatment first for the heart disease or Parkinson’s, but the depression may go untreated. By treating both illnesses at the same time, there are far better outcomes for patients and significant cost savings to the health care system.

Specialized centres like the Depression Research Centre are one important part of turning the tide in diagnosis and care of depression. To be effective, these centres need appropriate long-term funding to purchase and operate the technologies as well as attract and hold researchers to do the important studies that will change outcomes for patients.

To make our valued health care system sustainable for the future, Canada will have to invest in mental health. We can no longer manage the devastating impact of depression on human lives and our economy. The good news is that the investment will pay off in successful outcomes for patients and in financial returns. Statistics indicate that for every dollar we invest in diagnosing and treating depression, we will save another $7 in further health costs and $30 in lost productivity in our businesses.