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Medical Wellness Archives

Depression Is Underdiagnosed and Undertreated

2004: Volume 1, Number 1

 

It is estimated that up to 6 percent of men and 12 percent of women experience at least one episode of clinical depression during their lifetimes. An episode of depression can be mild to severe, or it can be chronic (dysthymia), lasting for at least two years.


An estimated 70 to 80 percent of patients with depression can be treated successfully, and usually feel better within weeks of beginning treatment. Because depression is biochemical in nature, anti-depressant medications are successful as a first-line defense in its treatment.


Underdiagnosed, Undertreated
Depression is one of the most underdiagnosed and undertreated health conditions within the primary care setting. 

 

Often, symptoms of depression are masked by anxiety, pain, or complaints of the gastrointestinal tract, chest, and pelvis. Symptoms of depression often co-exist with other health conditions (comorbidities) such as heart disease, diabetes, and asthma, which further complicates treatment. 

 

Recurrence rates are over 50 percent after the first depressive episode; 70 percent with two episodes; and over 90 percent with three or more episodes.


It’s recommended that practitioners screen patients for depression periodically, especially when anxiety, chronic conditions, and somatic complaints are present.

 

Screening For Depression
According to the National Depression Screening Project, there are nine symptoms that characterize clinical depression. Practitioners are encouraged to conduct a depression screening during patient encounters, especially when a chronic health condition is present.

  • Depressed mood

  • Diminished interest or pleasure in activities

  • Significant change in appetite and/or weight

  • Sleep disturbances

  • Restlessness or sluggishness

  • Fatigue or loss of energy

  • Lack of concentration or indecision

  • Feelings of worthlessness; inappropriate guilt

  • Thoughts of death or suicide

A person with clinical depression will have at least one of the first two symptoms and four of the remaining seven; symptoms will last for two weeks or more, and the person’s functioning will be impaired.
 

Traditional Clinical Approaches
 

MEDICATION THERAPY

Approximately 70 percent of patients with depression respond to monotherapy—use of antidepressant medication treatment alone.

PSYCHOTHERAPY

A variety of psychotherapy techniques, such as cognitive behavioral therapy, are used either alone for mild depression or in combination with medication for more severe cases.
 

LIGHT THERAPY

For Seasonal Affective Disorder (SAD), light therapy provides full-spectrum light to help manage seasonal bouts of depression.
 

ELECTROCONVULSIVE THERAPY

Considered standard treatment today, electroconvulsive therapy affects all neurotransmitters. It may be used when a patient is in immediate danger of suicide; or when other therapies are ineffective.
 

Other Approaches

 

EXERCISE

Moderate physical activity such as brisk walking, jogging, swimming, and cycling for 30 to 45 minutes, most days of the week, has been shown to help prevent and manage episodes of mild to moderate depression.
 

HERBAL

St. John’s Wort and SAM-e are common over-the-counter supplements used for self-treating mood disorders.

 

A recent trial conducted by NCCAM showed that St. John’s Wort was ineffective in treating major depression. In addition, St. John’s Wort is contraindicated for a patient who is taking drugs for HIV infection, birth control, cancer treatment, or anti-rejection drugs for organ transplants. All use of supplements that alter mood—including alcohol and illicit drugs—should be part of the patient’s health history.

 

Conclusion
In conclusion, because depression is underdiagnosed and undertreated, screening in a primary care setting should be routine, especially when there are comorbidities.


Sources

Depression at the Worksite: New approaches to health, disability, and productivity management. GlaxoSmithKline 2002.
Swartz KL, Margolis S. Depression and Anxiety. The Johns Hopkins White Papers, 2004.

 

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