Survey: Patients aren’t satisfied with treatment

Few report adequate depressive symptom relief

More than 20 medications on the market currently are approved for the treatment of clinical depression, yet the majority of people treated for this costly disorder report troublesome side effects and only modest improvement in their condition, according to a recently released survey conducted by the National Depressive and Manic-Depressive Association (NDMDA) in Chicago.

In an on-line survey of 1,370 people treated for depression, only 29% reported being satisfied with the treatment of their disease. "This survey gives a voice to many depression sufferers who cannot tolerate their antidepressant medication or aren’t satisfied with the improvement in their symptoms," says Lydia Lewis, executive director of NDMDA.

"While we know that treatment works for more than 80% of those suffering from a depressive illness, we still urgently need new strategies for managing depression. The solutions lie in continued research and improved dialogue between patients and physicians," she says.

The survey, conducted on-line during a six-week period in 1999 through the NDMDA Web site, screened for participants who had been treated for depression. Findings include:

• 78% of respondents said being treated for symptoms at the time of the survey.

• 81% said depression moderately or extremely impaired their social lives.

• 79% said depression moderately or extremely impaired their family lives.

• 72% said depression moderately or extremely impaired their job performance.

• More than 50% reported feeling misunderstood or disrespected by their physicians.

"Many physicians fail to take depression seriously," Lewis says. "I’m afraid few physicians approach depression with the same seriousness they would asthma or diabetes. It’s that stigma and ignorance that often sends depressed individuals running to the health food store to ask a minimum wage clerk whether or not St. John’s Wort will help alleviate their depression. It’s also what leads 20% of individuals with untreated or inadequately treated depression to take their own lives.

"We realize that this was not an objective scientific study. Individuals had to have Internet access, had to know about us, had to like to respond to surveys in order to participate," Lewis adds. "How ever, it gives us some serious food for thought. More important, the findings support those of other studies in the literature and should serve to raise the consciousness of the public and primary care physicians about the serious nature of depressive disorders." (For additional studies on the prevalence and treatment of depression in the United States, see box, below right.)

One size does not fit all

The survey also asked respondents currently taking antidepressants to rate their satisfaction with their medications. Findings include:

• 80% of respondents reported experiencing side effects that affected their willingness to continue treatment.

• 17% reported discontinuing medication due to side effects.

• 8% reported missing at least one dose of medication each week due to side effects.

• 28% reported no change in their condition since being treated for depression.

• 60% reported experiencing drowsiness from their antidepressant.

• 42% reported experiencing headaches from their antidepressant.

• 41% reported experiencing increased agitation from their antidepressant.

• 35% reported experiencing sleeplessness from their antidepressant.

• 33% reported experiencing impotence or other sexual dysfunction from their antidepressant.

"These results confirm our clinical suspicions that depression is difficult to treat and that the treatments we have are not totally effective," says David Dunner, MD, professor of departmental psychiatry and behavioral sciences and director of the Center for Anxiety and Depression at the Uni versity of Washington in Seattle. "No matter what clinicians may say about the scientific or representative nature of this on-line study, it still reflects the clinical status of individuals with serious mood disorders in this country. Many of them will get better, but nearly as many won’t improve with currently available treatments." (A table of current medications for depression and their most common side effects appears on p. 26.)

"No one antidepressant works the same for everyone with depression," notes Dennis Charney, MD, deputy chairman for academic and scientific affairs at Yale University School of Medicine in Princeton, NJ. "Each medication affects individuals differently. Physicians and patients should work together to explore all of the classes of antidepressant medication and determine the best treatment for their situation."

Yet another issue that interferes with treatment is health care funding, says Dunner. "Insurance companies sometimes restrict treatment or make treatment difficult for patients with serious mental disorders. In addition, they often restrict the use of medications in their formularies."

Patients on antidepressants must realize they do have many side effects, Lewis says. "These drugs all work, but they don’t all work in the same way or to the same degree for everyone. It’s important that case managers urge individuals being treated for depression to keep trying until they find the right treatment that helps alleviate symptoms and gives the fewest side effects. Serious depression cant be cured by a pill. It’s a chronic illness."

More reading on depression

- Conti DJ, Burton WN. Economic impact of depression in a workplace. J Occup Environ Med 1994; 36:983-988.

- Finkelstein SN, Berndt ER, Greenberg PE. Economics of Depression: A Summary and Review. Prepared for the National Depressive and Manic-Depressive Association-sponsored Consensus Conference on the Undertreatment of Depression. Chicago; Jan. 17-18, 1996.

- Greenberg PE, Stiglin LE, Finkelstein SN, Berndt ER. The economic burden of depression. J Clin Psychiatry 1993; 54:405-418.

- Hirschfeld RM, Keller MB, Panico S, et al. The National Depressive and Manic-Depressive Association Consensus Statement on the Under-treatment of Depression. JAMA 1997; 277:333-340.

- McFarland BH. Cost effectiveness consid erations for managed care systems: Treating depression in primary care. Am J Med 1994; 97(Suppl 6A):47S-57S.