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By Elinor Nelson
Americans are being treated for depression in record numbers, but
the treatment for many is falling short, according to a recent Harvard
Medical School study published in the June issue of the "Journal
of the American Medical Association." The study tracked 9,090 people
ages 18 or older and found that 6.6 percent had experienced depression
in the last 12 months (correlating to 13-14 million Americans).
Nearly 52 percent of those patients were treated, but treatment
was adequate for only 41.9 percent of those treated, resulting in
21.7 percent of all depressed patients receiving adequate treatment.
According to Ronald Kessler, Ph.D., principal author of the study,
an important finding was that the majority of patients were rated
"severe," making depression a "very clinically serious disorder."
Additionally, the study showed no strong demographic correlates
of treatment adequacy, with men and women, wealthy and poor, and
young and old all receiving about the same rates of inadequate treatment.
Kessler also found significant that "rates of treatment have increased
dramatically in the past decade," but that much of the increased
treatment is by primary care physicians who prescribe medication
but offer no therapy.
The shortage of treatment adequacy, says Kessler, is "very disturbing."
Adequate is defined as either four doctors' visits for medication,
or at least eight visits to a psychotherapist. The drugs prescribed,
Kessler notes, are often "the wrong medication or too low a dose
or the patient is not staying on the medication long enough."
Additionally, Kessler found that many people drop out of treatment
after only one to three sessions, even before their insurance stops.
Money is clearly "not the only issue," says Kessler, noting that
the situation is similar in Canada, where payment for treatment
is not an issue.
The greatest challenge, he says, is "holding the patient in treatment."
The study will continue in future years to explore who gets treatment
as well as the barriers to treatment.
Elizabeth Torres, Psy.D., assistant attending psychologist at McLean
Hospital and private practitioner in Belmont, is not surprised by
the study's findings. She sees a large part of her job as educating
her patients about depression and where the interface lies in biology,
psychology and the need for medication. Many people are reluctant
to take medication because "they want to do it on their own - they
think of medication as an artificial Band-Aid," Torres says. Also,
many of her patients are fearful of various drugs because of horror
stories they have read on the Internet, and it's up to her to provide
them with the facts.
Torres has not had "great experience with patients coming to me
after being treated by a general practitioner. There's no malintent,
but they're coming from a different perspective. They tend to under-medicate,
and don't explain the whole picture. It's more, 'here, take this,
it'll help you.'"
Torres agrees that rather than recognizing the cognitive and behavioral
shift that "has to happen," patients can be shortsighted about terminating
therapy once they begin to feel better.
Torres counters this situation with a "prediction of what may happen
again. I act like a consultant, and tell my patient the relapse
rates for depression. I point out the good things they're doing
to help themselves, and what may become problematic."
Torres explains how to know when symptoms return and develops a
collaborative plan with the patient. "I make myself available,"
Torres says. "I let them know that they can come back if things
get difficult." Many of her patients, she states, do return to therapy.
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