Treatment for Depression Often Misses Mark

Of the number of American adults who screen positive for depression, only 29 percent, or about one-third, receive treatment; conversely, many who are treated do not screen positive, according to a study published in JAMA Internal Medicine online, Aug. 29, 2016. Nevertheless, there has been a substantial increase in the number of antidepressant prescriptions, the most commonly prescribed class of medications in the U.S.

Given that increase, screening for depression is receiving increased attention. The U.S. Preventive Services Task Force now recommends screening adults for depression as well as initiation of services sufficient for adequate follow-up through a variety of interventions, and that treatment be targeted to an individual patient’s needs.

Range of Interventions. These interventions include monitoring, psychotherapy, or counseling; exercise, including yoga; pharmacological treatment and combination interventions. Antidepressants are not recommended for mild or less severe depression—placebo-controlled trials indicate that antidepressants are no more effective for mild depression than placebo.

What You Should Know

about Symptoms of Depression

  • Feeling sad, down, or blue most of the time
  • Loss of interest in activities and hobbies you once enjoyed
  • Disrupted sleep (difficulty getting to sleep or staying asleep, or sleeping too much)
  • Difficulty concentrating, paying attention, and remembering
  • Change in eating habits (overeating or losing your appetite)
  • Fatigue and loss of energy
  • Feelings of guilt or worthlessness
  • Feelings of helplessness or hopelessness
  • Increased alcohol and drug use
  • Irritability
  • Low self-esteem
  • Neglecting your personal care (such as personal hygiene)
  • Physical symptoms that don’t respond to treatment (headaches, stomach aches, chronic pain)
  • Reduced sex drive
  • Thoughts of death or suicide

Who Is Treated. The highest percentages of treatment included publicly insured individuals, and separated, divorced, and widowed persons. Patients with serious distress were almost twice as likely as those with less distress to be treated by a psychiatrist; the data showed also that about half of college graduates with serious distress were treated by psychiatrists, but less than one-third of people with less education were given psychiatric care.

Interestingly, older adults, including those with severe distress, were rarely treated with psychotherapy, probably because this group of patients prefers treatment in primary care settings where psychotherapy may not be available, the study found. However, even when psychotherapy was available, these patients selected antidepressant treatment.

Large numbers of people continue to go unscreened and untreated. Critical treatment gaps persist, particularly for racial and ethnic minorities, people with low incomes, less educated adults, and people without insurance, according to the study.

People who receive care for depression should receive treatment specific to their needs, study authors said. Data came from 46,417 responses to the Medical Expenditure Panel Surveys taken in 2012 and 2013.

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