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Karen Shelnutt, a writer and manager at Chapter 11 Books in Atlanta, has been battling depression for more than a decade.
It took her a long time, Shelnutt said, working first with a therapist and then with a psychiatrist, to hit on the right combination of "talk" therapy and medication.
At first she didn't recognize what she was suffering from. "Your mind gets messed up about your value and self-worth," she said. "You can't see anything in a positive light; everything takes a negative slant."
But, Shelnutt said, the more you know about depression, the easier the symptoms are to recognize. "Therapy helps you get that awareness, become more familiar with yourself and your moods," she said.
Like Shelnutt, more Americans are seeking help for depression. But nearly 80 percent of depressed people are not getting adequate treatment, a study published last week in the Journal of the American Medical Association reveals.
A major reason: Many are turning to primary care practitioners who do little more than prescribe drugs to their patients, rather than seek the help of a mental health specialist likely to treat the problem more aggressively, the study found.
The two-year nationwide study, funded by the National Institute of Mental Health, surveyed more than 9,000 adults. The study estimates that nearly 7 percent of U.S. adults, more than 14 million people, experience depression in a given year. Almost everyone in the study who reported being depressed said that it interfered with their ability to function at work, home, or in relationships.
Yet, only about 22 percent of people in the most recent survey received adequate treatment for their depression.
More than half of those surveyed who had been depressed in the previous year reported seeing some kind of health professional to discuss treatment. That's an improvement over 20 years ago, when only one in three depressed people sought treatment, according to previous surveys.
Of those who went to a mental health specialist, 64 percent were treated adequately, while only 41 percent of those treated by a general practitioner got sufficient care.
The minimum treatment considered adequate by the study's authors consisted of either eight half-hour psychotherapy sessions or four visits with any health professional in conjunction with anti-depressant treatment lasting at least a month. Studies have shown that the most effective treatment for depression is a combination of psychotherapy and drug treatment.
That's because drugs such as Prozac treat some of the symptoms of depression but don't address the underlying cause. Antidepressant drugs make it easier for depression to be treated in the primary care setting, said Dr. Benjamin Druss of Emory University's Rollins School of Public Health. But, he said, physicians in primary care settings often lack the resources to provide the longer-term follow-up depressed patients need.
"The message is not that primary care people don't know what they're doing," said Kathleen Merikangas, one of the lead investigators of the study. The key is getting patients referred to mental health specialists for counseling, the authors concluded.
But there are several barriers keeping depressed people from getting the help they need. One is the disparity between insurance coverage for mental vs. physical ailments. Some insurance plans will cover only a certain number of visits to a mental health specialist. Another hurdle is the stigma frequently attached to mental illness that keeps people from seeking treatment.
After getting patients in the door, Dr. Jennifer Kelly, an Atlanta psychologist, said, the main challenge facing mental health professionals is getting depressed patients to stick to their treatment.
She said patients often have unrealistic expectations for antidepressant drugs. "It's all these commercials on TV; people think they can take this pill today and feel better tomorrow," Kelly said. "Then when they don't get that magic pill, many get frustrated and give up."
Merikangas said the best thing people can do is educate themselves about depression, learn to recognize the signs, and understand the treatment options available. "People should be armed with information," she said. "There's nothing better than that."
Copyright 2003 The Atlanta Journal-Constitution
