Depression becomes more difficult to treat the longer it goes undiagnosed or undertreated

Eli Lilly and CompanyOct 15 2009

A new survey of 2,001 adults living with depression revealed that despite being diagnosed for an average of 12 years, many unknowingly took actions that could have sabotaged their chances of getting well. Furthermore, on average, it took about six years for respondents to seek diagnosis from a health care professional, suggesting these adults may have been coping with depression for as long as 18 years.

Depression, which includes a variety of symptoms, is a highly treatable illness, but it can become more difficult to treat the longer it goes undiagnosed or undertreated. The survey showed that among those who waited six months or more to be diagnosed, 69 percent reported they delayed diagnosis because they lacked knowledge about depression or lacked basic facts about available depression treatments and where to go for help. Additionally, among those who wanted more information about depression treatment at the time of diagnosis, 64 percent said they wanted to know what it means to "get well." Surprisingly, 91 percent have been prescribed an antidepressant for depression, but among them, just seven percent felt very knowledgeable about all basic aspects of the treatment.

The survey is part of a new depression educational program called Missing Pieces, which was developed by leading mental health experts and supported by Eli Lilly and Company to help people identify the information they need to better understand depression. Overall, the survey demonstrated that many adults with depression are engaging in unhealthy behaviors that may jeopardize recovery, such as:

• Nearly three in five (57 percent) of those who delayed seeking a diagnosis felt they could manage their own depression symptoms.
• Among respondents who had taken antidepressants for depression, nearly half (47 percent) did not discuss when it might be necessary to change medications with their doctor, despite the fact that they were still experiencing depressive symptoms.
• Among those who have stopped taking antidepressants, about two in five (41 percent) did so without telling their doctor.
• More than 70 percent (71 percent) noted that talk therapy should always be part of a depression treatment plan, yet only 22 percent were currently enrolled in talk therapy.

"The survey strongly suggests that many people living with depression are unaware or are 'missing pieces' of vital information that may be preventing them from getting well," said Dr. Susan Kornstein, professor of psychiatry and obstetrics and gynecology at Virginia Commonwealth University. "Depression needs to be treated by a health care professional. To increase the likelihood of recovery from depression, it's important that people with depression have a comprehensive treatment plan that may include medications, psychotherapy and lifestyle changes. The goal is to help them to recovery."

Three-Step Action Plan

The survey revealed key areas of information that people with depression are missing. In response,

The Missing Pieces expert panel recommends three simple steps to help guide people from diagnosis to recovery of depression:

Step One: Two Week Rule for Diagnosis of Depression

Current American Psychiatric Association guidelines state that adults experiencing at least five of the symptoms of depression for two consecutive weeks, and at least one of them is depressed mood or loss of interest, they should talk to a health care professional. Additional symptoms of depression can also include feelings of guilt or worthlessness, thoughts of death or suicide, restlessness, trouble concentrating or making decisions, fatigue, lack of energy and changes in weight or sleep patterns. Additional symptoms of depression may include pain, irritability and anxiety.

Step Two: Six Week Rule for Seeing Improvement in Depression Symptoms

To get fully well, it is important to address all of the symptoms of depression. Experts recommend that individuals on any type of treatment plan for depression who are unsatisfied with their level of improvement should consider consulting with their doctor about making changes to their treatment plan.

Step Three: Managing Your Depression Treatment Plan When Feeling Better

If an individual has found a depression treatment plan that is addressing many of their depression symptoms, they should continue on that treatment for at least another four to nine months to help prevent the return of their symptoms. Some individuals will also need long-term maintenance treatment to help prevent future episodes of depression.

In addition to this three-step plan, Missing Pieces offers an educational Web site, found at www.MissingPiecesProgram.com, which provides more survey details and in-depth information about depression. The Missing Pieces program was driven by a multi-disciplinary expert panel that helped shape the development of all educational materials including the national survey and Web site content:

• Dr. Susan Kornstein, professor of psychiatry and obstetrics and gynecology at Virginia Commonwealth University
• Dr. Sally Edwards, family practice doctor at Woodinville Primary Care in Seattle, Washington
• Dr. W. Clay Jackson, clinical assistant professor of psychiatry at the University of Tennessee College of Medicine
• Dr. Thomas Wise, professor of psychiatry, George Washington University School of Medicine