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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. |
