When Depression Goes Untreated
Too often, psychiatrists say, people who could benefit don't seek help
What alarms many experts more than overdiagnosis is that depression is too often missed in those at risk of harming themselves. Some people are reluctant to get help, perhaps because they don't consider depression to be a legitimate medical condition or they lack insurance coverage. Others may have been scared off by the recent "black box" warnings on antidepressants citing an increased risk of suicidal thoughts and tendencies in young people who take them. Yet treatment appears to save lives: A study published in the July issue of the American Journal of Psychiatry found a reduced risk of suicide attempts among 100,000 patients treated for depression during the first month of treatment—regardless of whether they used medication, psychotherapy, or both. U.S. News asked American Psychiatric Association President Carolyn Robinowitz and the APA's director of research, Darrel A. Regier, to explain the impact of underdiagnosis.
What's the danger of not treating depression?
Robinowitz: Suicide, of course, is the biggest risk, but depression also has been shown to increase the likelihood of health problems such as heart disease, strokes, and diabetes. This is partly because depressed individuals often don't take care of themselves in terms of exercise and healthy eating.
Why do you think the bigger problem is underdiagnosis?
Regier: Many individuals have a tough time recognizing depression in themselves or a family member. They might think their symptoms are just a normal reaction to everyday stress. Unless patients come in announcing that they're depressed, primary-care physicians tend to focus on a chief complaint like fatigue or sleeplessness and don't probe further to see if it's clinical depression.
Are the black box warnings of suicide risk on drugs creating a chilling effect?
Robinowitz: Definitely. We've seen an increase in teen suicides since these warnings have gone on packaging because fewer teens who need treatment are getting it.
Regier: Some general practitioners are simply less willing to treat their young patients with antidepressants. What worries me, too, is that a few grassroots organizations have started to spread the word that no mental disorders should ever be treated with drugs. Instead of carefully weighing the risks of antidepressants against the benefits, these groups push the agenda that mental illness is a controllable state of mind, not a disease.
What do you think of TV commercials advertising antidepressants?
Regier: They're a mixed bag. You can have people overinterpreting what the symptoms mean for them. On the other hand, the ads are helpful as a tool to educate people that they might need help.