*This is an archive page. The links are no longer being updated.
1993.04.14 :  Treatment of Depression

Contact:  Bob Isquith (301) 227-8364 ext.  173
Valna Montgomery (301)227-8364 X 170
April 14, 1993

       A federally backed panel of health care experts today
urged family doctors and other primary care providers to be more
aggressive in detecting and treating major depression -- which
the panel emphasized is a medical disorder that can disable the
patient and sometimes lead to suicide.
       The panel, which developed guidelines sponsored by the
Agency for Health Care Policy and Research, said major depression
can almost always be treated successfully.
       The group stressed that early detection and treatment can
shorten the depression, lessen disability and cut costs -- and
appears to be more effective.  Primary care providers, the panel
said, should go beyond a patient's initial complaint, such as
chronic headache, to ask about emotional, mental, behavioral and
other physical symptoms of major depression.
       HHS Secretary Donna E. Shalala said, "The expert panel
urges patients and care-givers not to see depression as laziness,
moral weakness or the blues, but as a medical illness -- one that
can almost always be treated successfully, and the sooner the
better."
       More than 11 million people in the United States suffer 
depression and one in eight Americans will be affected sometime
in life.  Up to two-thirds of all sufferers either do not seek
treatment, or if they do, are inadequately diagnosed or treated. 
       Major depression, which affects people of any age but
strikes women twice as often as men, costs the nation at least
$27 billion in 1989 in medical care, worker absenteeism and
related costs. 
       The clinical guidelines were developed for the Agency for
Health Care Policy and Research, an arm of HHS' Public Health
Service, by a private-sector panel composed of psychiatrists,
primary care physicians, a clinical psychologist, a psychiatric
nurse, a social worker, and a consumer advocate.  
       Major depression, which is a form of clinical depression,
is characterized by symptoms such as sad mood, low energy, loss
of interest in usual activities, difficulty concentrating,
changes in eating or sleeping, and suicidal thoughts.  Risk
factors include family history and genetics, other illnesses,
certain medicines and drug or alcohol abuse.           
       According to the panel's chair, A. John Rush, M.D.,
director of the mental health clinical research center at the
University of Texas Southwestern Medical Center in Dallas,
primary care providers are trained to treat many common types of
depression and, in fact, treat more than half of all depressed
patients.  However, the illness can be difficult to recognize and
accurately diagnose.  Primary care providers often fail to
recognize underlying depression and instead treat the disorder's
physical manifestations, such as chronic headache and stomach
problems.        
       The panel, which was formed in 1990, reviewed more
than 3,500 studies and sought information from a wide range of
organizations.
       Among the panel's findings for treating major depressive
disorder are that: 

          o    Depression can almost always be treated
               successfully, either with medication,
               psychotherapy, or a combination of both. However,
               combined therapy should not routinely be the first
               treatment for all depressed patients.

         o     Not all patients respond to the same treatment. A
               patient who fails to respond to the first
               treatment attempted is highly likely to respond to
               a different treatment. 

         o     An initial trial of antidepressant medicine
               relieves depressive symptoms in over half of all
               outpatients with moderate or severe major
               depression.  It is also effective in some patients
               with milder depression.

         o     Time-limited psychotherapy alone is associated
               with a  better than 50 percent response rate in
               outpatients with mild to moderate major
               depression. If psychotherapy produces no effect by
               six weeks or nearly full remission of symptoms
               within 12 weeks, switching to medication is
               strongly recommended.

         o     Combined treatment is called for in more complex,
               chronic, or recurrent cases, or for those with
               only partial responses to either medication or    
               psychotherapy alone. 
         
         o     Medication alone or in combination usually
               produces a  marked improvement by six weeks.
               Psychotherapy usually produces some improvement by
               six weeks, but may require up to 12 weeks for a
               full effect.

         o     Psychotherapy (alone or in combination) can also
               be helpful to improve adherence to medication or
               help with family or work problems.  
   
       "All treatments have some risks for patients," said Dr.
Rush. "To choose the right treatment, the patient needs to take
both the benefits and risks of various treatments into
consideration."
       According to the panel, antidepressant medications are not
addictive and, when properly administered, are not dangerous. 
Some antidepressants produce mild to moderate temporary side
effects.  The guidelines recommend that health care providers
monitor all patients closely, particularly older persons and
those with chronic illnesses, since they tend to have more
adverse reactions to antidepressants.
       However, it is important that patients who have major
depression stay on their medication until told to discontinue its
use.  Some patients may have to stay on medication for months
after symptoms have disappeared to reduce the likelihood of
relapse. 
     The guideline also addresses light therapy,
electroconvulsive therapy, and the diagnosis of other types of
depression, such as bipolar, or manic-depressive disorder,
dysthymia -- more chronic, less episodic depression -- and "not
otherwise specified" depression. 
       "Widespread adoption of these practice guidelines will
benefit everyone -- patients, their families, providers, payers
and employers," said AHCPR Administrator J. Jarrett Clinton,
M.D., M.P.H..
       AHCPR will distribute the guidelines to primary care
providers, including physicians, nurse practitioners, mental
health nurse specialists, physician assistants, social workers
and others through national and state professional societies and
journals.  In addition, copies of the two-volume Depression in
Primary Care --which covers detection and diagnosis for most
forms of depression, and the treatment of major depressive
disorder -- an accompanying quick reference guide for providers,
and an easy-to-understand guide for patients (a Spanish-language
guide will be available later), are available free by sending a
post card to: DEPRESSION, P.O. Box 8547, Silver Spring, MD 20907,
or by calling 1-800/358-9295.  

                                ###