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Managed health care often a factor in missed diagnoses of depression

Because depression is poorly identified by patients and physicians alike, a USC psychiatric pharmacist said that depressed people do not always receive the help they need.

“A diagnosis of depression in a primary care setting continues to be under-recognized, and when diagnosed, is often inadequately treated,” said Glen Stimmel, professor of clinical pharmacy, psychiatry and the behavioral sciences, School of Pharmacy and Keck School of Medicine.

Stimmel, who has written extensively about depression, said that due to managed health care, a majority of depressed people are treated exclusively by a primary care physician instead of seeking help from a psychiatrist, which contributes to missed diagnoses and inadequate treatment.

“Primary care physicians don’t always have enough time with a patient and don’t ask the right questions in order to diagnose depression correctly,” said George Simpson, professor and interim-chair of the Keck School’s Department of Psychiatry and the Behavioral Sciences. “Patients may be afraid to discuss symptoms of depression and may be embarrassed about the stigma associated with the disease.”

Primary care physicians are trained to focus on physical complaints to rule out medical conditions such as diabetes and thyroid disorders, which are often characterized by symptoms of depression. This is especially problematic for senior citizens with symptoms of fatigue or dementia; two of the major warning signs for depression in that age group.

“Some physicians associate memory impairment and lack of energy solely with old age, when in reality, the senior citizen may be depressed,” said Simpson.

Along with a proper diagnosis, successful treatment of patients with depression requires careful monitoring and “fine tuning” of antidepressant medication over time, said Stimmel.

Antidepressants work by restoring the balance of neurotransmitters—specifically of serotonin and norepinephrine—to normal levels in the brain, creating a domino effect that alleviates depression symptoms.

The drugs must be taken for at least two to six weeks before most people see a noticeable change in their mood. After the depressive symptoms subside, patients need to keep taking the medication for a total of six to twelve months to prevent recurrence.

Side effects are common when a patient first begins treatment and are usually dose dependent. As the body gets used to the drug, many side effects will either subside or decrease in severity.

“Patients need to understand the side effects of antidepressants so they know what to expect,” said Michael Wincor, associate professor and interim-chair of the Department of Pharmacy at the School of Pharmacy. “It is crucial for a depressed individual to have faith that they will feel better in six weeks—and that experiencing side effects means that the drug is working.”

Despite advances in drug therapy, patient education remains an obstacle in the treatment of the depression. The first crucial step towards recovery is recognition of depressive symptoms—and acknowledgement that depression is a serious, medical condition that must be treated by a physician.

“Many patients are hesitant to discuss feelings of depression with their physician since that would require an admission of emotional weakness. Other patients are uninformed about depression, believing that their symptoms are a natural part of life,” said Stimmel. “Physicians and pharmacists can help their patients recover from depression by investing time for education, by understanding the perspective of the patient and by negotiating treatment options.”

Managed health care often a factor in missed diagnoses of depression

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