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Depression Treatment – Critical Gaps Need To Be Addressed

Depression Treatment – Critical Gaps Need To Be Addressed

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  • Less than a third of the people who screen positive for depression received treatment
  • People from lower socioeconomic strata and with less education more likely to be depressed
  • Access to treatment is unavailable to racial minorities, the poor and the uninsured.
  • Such critical gaps in treatment of depression have to be addressed

National Survey on Treatment for Depression

Depression is a fairly commonly occurring disorder worldwide. A recent national survey conducted in the US threw up some startling revelations.


Scientists from Columbia University Medical Center (CUMC) and the University of Pennsylvania studied data from a national survey that focused on the treatment of depression. The survey involved over 46000 adults, and was conducted in 2012 and 2013. It collected information regarding symptoms of depression, severe psychological distress, whether people were being treated with antidepressants, psychotherapy or both, the types of health care professionals that were providing treatment, and other data such as age, gender, race, education, marital status, income and health insurance status.

Results of The Study

The study revealed the following facts, some of them were startling.

The incidence of depression was nearly five times higher amongst individuals in the lower income group than in people belonging to the high income group. It was also seen fairly commonly among adults who were divorced, separated or widowed, had public health insurance or had not studied beyond a high school education.

Persons, who were highly likely to receive treatment included those with publicly-insurance, and separated/divorced/widowed people, whilst those least likely to get treatment included the uninsured, racial and ethnic minorities and men.

Surprisingly, most people (70.1%) who were being managed for depression did not screen positive for depression on the two-question screen. Though this finding seems surprising, it was not totally unexpected.

Prescriptions for anti-depressants had become so rampant in the 1990s that a few people began referring to the United States Prozac Nation. Many of the prescriptions were not given for actual depression. These days, even some pets are known to take Prozac. Still the finding shows that's there's a huge mismatch between those who are suffering from depression, and those who are being actually treated for it.

The study concluded with an observation that less than a third of persons screening positive for depression received treatment in the last year.

Lessons From The Study

Healthcare providers should pay more attention to the severity of a person's depression and then treat based on each individual patient's needs.

"These patterns suggest that more needs to be done to ensure that depression care is neither too intensive nor insufficient for each patient. Although screening tools provide only a rough index of depression severity, increasing their use might nevertheless help align depression care with each patient's needs," said Mark Olfson, MD, MPH, professor of psychiatry at CUMC and senior author of the report.

The study concludes saying that: "Although access to depression care has expanded in recent years, critical treatment gaps persist, especially for racial/ethnic minorities, low income individuals, less educated adults and uninsured people."

About Depression

Depression (major depressive disorder or clinical depression) is a fairly common occurrence, but a serious mood disorder. Severe symptoms occur, that may affect how one feels, thinks, or copes with daily activities, such as eating, sleeping or working. Diagnosis requires symptoms to have been present for at least 2 weeks to make a diagnosis.

Prevalence of Depression

The World Health Organization (WHO) has ranked depression as the fourth leading cause of disability worldwide and predicts that by 2020, it will become the second leading cause.

Signs and Symptoms of Depression

  • Constantly feeling sad, anxious, or "empty"
  • Hopelessness, despair, or negative feelings
  • Irritability
  • Frequent thoughts of death or suicide, or attempt to end one's life
  • Feeling guilty, and worthless
  • Sudden loss of interest and pleasure in hobbies and leisure activities
  • Decreased energy or feeling of tiredness
  • Slow deliberate movements, speaking slowly
  • Feeling restless and fidgety
  • Difficulty in concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Vagueaches or pains, headaches, cramps
  • Digestive problems

Depression Treatment

Even the most severe cases of depression can be treated. The earlier the treatment begins, the more effective will be. It is usually managed with medications (anti-depressants), psychotherapy (counseling and cognitive behavior therapy, interpersonal therapy), or a combination of both. If these treatments do not cause improvement in symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to try out for the possibility of a cure.

Role of Self Care in Depression

Having depression can make it quite difficult to find the energy and enthusiasm to take care of oneself. However, taking an active role in one's treatment, trying to help oneself cope with various experiences, may make a big difference in how one feels. Some of the things that one needs to do include:
  • Eating and sleeping well
  • Being active and indulging in exercises such as walking or cycling
  • Keeping good personal hygiene
  • Avoiding drugs and alcohol
  • Creating time to do things that one enjoys
  • Volunteering or joining a support group
  • Challenging negative thoughts
  • Trying out new things
  • Maintaining a mood diary to monitor progress
References :
  1. About Depression - (https://www.nimh.nih.gov/health/topics/depression/index.shtml)
  2. The epidemiology of depression across cultures - (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100461/)
  3. Depression - General Information - (http://www.mind.org.uk/information-support/types-of-mental-health-problems/depression/self-care-for-depression/#.V9vFK_l97IV)

Source: Medindia

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