CHICAGO -- Treatment rates for major depression have improved significantly over the last two decades, but more than half of patients nationwide are getting inadequate therapy, a new study suggests.
The findings suggest that while the stigma of mental illness may be easing, many doctors may not be aware of treatment advancements, and many patients may be seeking unproven therapies, said Harvard Medical School researcher Ronald Kessler, the study's lead author.
"That's the most disturbing thing of all," Kessler said. "After all these years of trying to get them in ... we've screwed up."
The nationally representative study of 9,090 people aged 18 and up found that about 57 percent of participants with recent major depression had received treatment. That rate is nearly 40 percent higher than rates reported in the early 1980s, the researchers said.
Treatment was considered adequate or adhering to accepted guidelines in only 21 percent of patients with recent depression.
The findings, published in Wednesday's Journal of the American Medical Association, are based on face-to-face psychiatric evaluations conducted from February 2001 to December 2002.
Overall, 6.6 percent of patients had major depression sometime within the previous year, which equals up to about 14 million U.S. adults.
The overall prevalence is slightly higher than rates reported a decade ago but whether it represents a true increase or just better recognition of depression is uncertain, Kessler said.
The National Institute of Mental Health estimates that depression afflicts 9.5 percent of adults in any given year, or about 19 million, but those figures are based on old data that were less strict than the current survey's criteria, Kessler said.
Depression was moderate to severe in 90 percent of study participants, while the older data may have included mild cases that would not be diagnosed as depression today, he said.
Depression was more common in women and adults aged 18-44 than in men and adults over 60. Rates were similar nationwide.
The increases in people seeking treatment show recent campaigns by the government and others to raise awareness about depression are paying off, said co-author Kathleen Merikangas, a researcher at the National Institute of Mental Health.
"The increase makes me optimistic but I do think there's room for improvement," Merikangas said.
Dr. William McKinney, a Northwestern Memorial Hospital psychiatrist, said the results mean "unfortunately a lot of people with this illness are going to their doctors and being put on some anti-depressant maybe for an inadequate dose for inadequate time.
"These people are left with a lot of disability," said McKinney, director of a depression research and treatment center at Northwestern University's medical school.
Research has shown that a combination of medication and psychotherapy is best, but treatment needs to be tailored to the individual patient, Kessler said.
Another JAMA study estimates that depression costs U.S. employers $44 billion yearly in absenteeism and lost productivity, $31 billion more per year than related costs from nondepressed workers.
Those costs don't include labor costs associated with disability leave, said lead researcher Walter Stewart, an epidemiologist with Geisinger Health Systems in Danville, Pa.
Depression "is mostly invisible. Co-workers don't know about it, employers aren't aware of it" and doctors don't always question patients with possible symptoms about it, Stewart said.
The challenge is "trying to understand how to motivate both workers and employers and health care providers how to better manage this condition," he said.
The researchers conducted telephone interviews last year with a nationally representative sample of U.S. workers aged 18 to 65.
Depressed workers reported an average of about 5 1/2 hours weekly of lost productivity or absenteeism, compared with 1 1/2 hours weekly among nondepressed workers. Stewart said the researchers assumed depression was a major factor in those rates, but don't know for certain.
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