Barriers to treating depression
STEPHEN HEIDEL
San Diego Daily Transcript , Wednesday, April 3, 2002
Depression is a serious illness that affects eight percent of the adult population in the United States -- 20 million people -- each year. Depression causes both great despair to those individuals suffering from it and problems in the workplace including absenteeism, loss of concentration, irritability, co-worker conflict, lack of motivation and lost opportunities.
In the past decade there have been tremendous strides made in the treatment of depression. Skilled clinicians can now diagnose and effectively treat depression, using psychotherapy and/or medication. Nevertheless, there are many barriers preventing individuals with depression from receiving effective treatment. These barriers include:
- Lack of knowledge. When individuals have a depressed mood -- loss of interest in most activities, change of weight, change of sleeping habits, loss of energy, feelings of worthlessness, loss of the ability to concentrate, and thoughts of death -- they are probably suffering from depression. People may know they do not feel well or recognize they are irritable, but may not know they are suffering from a very common and treatable medical illness. These individuals, their families and co-workers all suffer because they do not know effective treatment is available.
- Stigma. All mental illness, including depression, has stigma attached to it. Employees who are depressed often feel shame and are embarrassed to tell other people what they are thinking and feeling. If they are labeled as a "mental patient" they fear losing their job or any chance for advancement.
- Ignorance about treatment. Many people assume there is little they can do to feel better. They think treatment is ineffective, traumatic or time consuming. They may recall the traumatic treatment depicted in the amusing (but inaccurate) movie "One Flew Over A Cuckoo's Nest" or think they will have to spend years on a couch telling a psychiatrist everything they can remember about their mother. They may have talked to a neighbor who told them a story about someone who went for treatment and never got better. They do not know that eighty percent of people with depression respond well to appropriate treatment.
- Fear of medication. Many people think taking medication for depression is either addictive or toxic, causing serious side effects. Others do not want to take medication because they only want to take natural products. The reality is medication for depression is not addictive and may be necessary to correct a chemical imbalance in the brain. There are ways to manage side effects, either by changing the dose or changing the medication.
- Lack of physician training. Some physicians have little experience treating depression. They may not know how to prescribe a variety of antidepressant medications or to adjust the dosage when they do not have their desired effect. They may neither educate patients about what to expect or schedule frequent follow up appointments. Some physicians feel people with serious illnesses have earned the right to be depressed and everyone should accept it. They may not understand that depression is a separate illness and needs to be treated aggressively, both to help their patient function better and to improve their chances of recovery from their medical illness.
- Limitations by insurance carriers. Many insurance companies are afraid of insuring mental illness. They think depression is poorly defined and treatment is a black hole. These insurance companies may try to make it difficult for a person with depression to access appropriate treatment or find ways to place severe limitations on the treatment available.
- Employer ignorance. Many employers do not know that eight percent of their employees will suffer from depression this year and much of the cost burden will fall on them in the form of lost productivity. They may worry about the American with Disabilities Act, fearing an employee with depression will need to be accommodated forever. They do not understand that treatment is usually brief and returns employees to their previous performance level.
The workplace can help employees overcome these barriers, receive needed treatment and return to previous levels of productivity. Education is effective. Examples include inviting professionals to speak about depression at lunchtime seminars, displaying simple brochures about depression in the human resource manager's office and at health fairs, and training supervisors to be on the lookout for employees whose behavior has changed for the worse and to refering them to their employee assistance program. Employers should also talk with their insurance broker to insure their health plan has good mental health benefits and easy access to a high quality panel of mental health professionals.