Depression Treatment: Too Little and Too Much

By Jane Farrell

Although depression is commonly discussed in the media, researchers have found that most Americans affected by the condition don’t receive treatment. At the same time, the investigators found, it’s possible that overtreatment of depression is widespread.

Less than a third of American adults who screened positive for depression received treatment for their symptoms, whereas over two-thirds of adults receiving treatment for depression did not report symptoms of depression or serious psychological distress, according to a study from Columbia University Medical Center (CUMC) and the University of Pennsylvania.

The study also found that among those who are treated for depression, less than half of those with severe psychological distress are seen by a mental health specialist.

The study results were published in JAMA Internal Medicine.

“Greater clinical focus is needed on depression severity to align depression care with each patient’s needs,” said Mark Olfson, MD, MPH, professor of psychiatry at CUMC, psychiatrist at NewYork-Presbyterian/Columbia and senior author of the report. “These patterns suggest that more needs to be done to ensure that depression care is neither too intensive nor insufficient for each patient. 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.”

The researchers analyzed data from a national survey conducted in 2012 and 2013 of more than 46,000 adults focusing on the treatment of depression. They examined depressive symptoms, serious psychological distress, treatment with antidepressants and psychotherapy, health care professionals providing treatment, and other variables including age, gender, race, education, marital status, income, and health insurance.

Approximately 8.4 percent of respondents screened positive for depression, and roughly 8 percent of respondents had been treated for depression. Among adults who screened positive for depression, women, whites, privately insured adults, and college-educated individuals were more likely to receive depression treatment.

There were also differences among groups in the treatments received. Among those with serious psychological distress, for example, four times as many younger adults received psychotherapy and antidepressants than older adults, and twice as many college-educated adults received both treatments than adults with a high school education.

“With the increase in antidepressant use over the last several years, it may come as a surprise to learn that widespread challenges persist in accessing depression care,” Olfson said. “There are also challenges in connecting depressed patients to the appropriate level of care.”