by Ernie Hood
Many U.S. adults with depression are not receiving treatment, while many others are receiving treatments that do not match the severity of their illness, according to major publication in JAMA Internal Medicine, Treatment of Adult Depression in the United States.
Researchers from the Columbia University Medical Center and the University of Pennsylvania analyzed data on the treatment of depression from a recent national survey of more than 46,000 adults.
The analysis suggests that most Americans with depression receive no treatment at all, but among certain groups, overtreatment is widespread. Approximately 8.4 percent of adults in the survey screened positive for depression, but less than onethird (28.7 percent) of that group received any depression treatment during the survey year.
“It may come as a surprise to learn that widespread challenges persist in accessing depression care,” said Dr. Mark Olfson, a professor of psychiatry at Columbia and senior author of the report. Racial and ethnic minorities were particularly less likely to receive treatment, and similar gaps were prevalent among low-income people, less-educated adults, and people without insurance.
On the other hand, according to the study, “the large percentage of treated patients who screened negative for depression and did not have serious distress raises the possibility of overtreatment.”
Part of the overtreatment story may stem from the fact that most patients who were treated for depression were seen exclusively by general medical professionals (73.3 percent), who were more likely to rely on antidepressant therapy than psychotherapy or other modalities and less likely to screen their patients carefully for serious distress. Ironically, “patients with less serious distress were more likely than those with serious distress to receive antidepressants,” the report observed, despite the fact that “antidepressants are generally not recommended for patients with mild or less severe depression.”
“Greater clinical focus is needed on depression severity to align depression care with each patient’s needs,” said Olfson. “These patterns suggest that more needs to be done to ensure that depression care is neither too intensive nor insufficient for each patient.”
He and his co-authors think one way to accomplish the appropriate balance of need and care would be to encourage more use of validated screening tools, particularly in the primary care setting. “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,” he noted.
Tests like GeneSight use a patient’s genetics to give healthcare providers information on how the patient will respond to different antidepressants, helping the clinician choose a medication that is more likely to work for an individual patient. Of course, even if enhanced alignment is accomplished through escalated screening, challenges to effective, appropriate depression treatment will remain. For example, access to mental health professionals is sometimes limited, particularly in rural areas, resulting in some of the clinical over reliance on antidepressants. The researchers suggest that general medical professionals consider adopting some of the simpler types of psychological interventions for use with their less-distressed patients, such as counseling, yoga, and exercise.