Dearth of depression treatment

If you’re feeling down and out but struggling to get through
it on your own, you’re not alone.

A large new survey has found that only half of those in the
United States with depression
are receiving any sort of treatment for the condition—many because they have
not been formally diagnosed.

For the study,
which appears in the January issue of Archives
of General Psychiatry,
researchers assessed nearly 16,000 people to study
how commonly depression occurs in the United States and what kinds of treatment
people with the disorder receive. Because the participants were carefully
selected from three large national surveys instead of from hospital records,
the survey represents a snapshot of the U.S. population as a whole, the
scientists say.

“We can talk about population estimates for the whole of the
U.S. Ours is a cross-sectional, nationally representative sample,” says lead
author Hector
, an assistant professor of family medicine and public health
sciences at Wayne State University in Detroit. “That’s the beauty of our

Approximately 9 percent of the participants either met the
criteria for depression or had met them sometime within the past 12 months. Of
those with depression, only half had received any treatment for the condition
and only one-fifth had received treatment that conformed to the American Psychological Association’s recommended

Because the survey team assessed each person independently
for depression based on data and interviews, those numbers include many people
who have not been officially diagnosed by a physician, González says. He does
not have firm numbers on how many people that might be but expects they
represent a significant proportion of the U.S. population.

If the sample is indeed representative, then the country holds
roughly 14 million untreated residents. People with untreated depression are
not only in danger of jeopardizing their jobs, personal relationships, and
general health, but many also have an increased risk of harming or killing
themselves. According to the Dana Guide to Brain
, approximately 20 percent of depressed people will make a suicide
attempt and around 6 percent will ultimately succeed.

The survey also found that therapy is used to treat
depression more often than drugs. Although the study didn’t directly address
the reasons, one cause for the disparity might be that antidepressants seem to
work only for those patients with the most severe cases of depression. A study released
in the Journal of the
American Medical Association
found that for mild to moderate cases of
depression, drug treatment was similar to treatment with a placebo pill. “Only
15 percent of people in the U.S. with depression have very severe depression,” González
says. “So 85 percent don’t respond to antidepressants better than placebo.”
This doesn’t mean that the drugs have lost favor, though, he adds; half of the
antidepressant prescriptions doctors now write are for conditions other than

The scientists also looked at whether incidence and
treatments differed among particular ethnic subgroups. While overall rates of
depression were similar to the national average among all groups, González
says, African and Mexican Americans had a notably reduced chance to receive
both any care at all and the recommended treatment.

The scientists plan to use their results and additional data
to see what kinds of treatments are most effective against depression.
“Depression is a leading cause of disability worldwide,” González says. “We
think we can help meet the health needs of Americans and others, by seeing how
well these people are supported.”

—Aalok Mehta

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