
Most Depressed Adults in the U.S. Remain Untreated - aburan28
http://www.scientificamerican.com/article/most-depressed-adults-in-the-u-s-remain-untreated/
======
empath75
I'd wager that the vast majority of people that would test as being depressed
are depressed because they are in a crappy life situation for one reason or
another. I was depressed to the point where I barely left the apartment for 2
years, other than to go to work. You know what got me out of it? I bumped into
an old friend who had just come back to the US from an extended backpacking
trip. I ended up quitting my job and backpacking for 3 months. It totally
changed my perspective on life, and I met my now-wife, who was also
backpacking, and we currently have a kid and I have a much better job than I
had before I left. Turns out I was depressed because I was bored and lonely,
and all I really needed was a kick in the ass to get moving again.

There are obviously lots of people who seem to be depressed out of all
proportion to what's going on in their life, and would benefit from
antidepressants to get them going again, but I really don't think that it
should be a first resort for all of them.

~~~
vlunkr
This is the difficult thing about clinical depression, how do you know if it's
truly a chemical imbalance or just the normal reaction to your situation?
Sure, there are these screenings, but in my non-professional opinion they are
pretty bad. Maybe it's an epidemic of false positives on depression
screenings.

~~~
zepto
The chemical imbalance theory has little scientific support.

~~~
davymac
Google Dr Robert Sapolsky.

~~~
zepto
Google the area of chemical imbalance as an explanation for depression.

------
sosuke
There is a line of thinking I see that I wanted to address. The idea that
someone isn't depressed but instead are really unhappy with their lives, work
or situation. It's been pointed out already that the difference is difficult
to test.

The problem that thought doesn't address is how impossible it can be to change
your life, work or situation. People in abusive relationships can feel trapped
and even when a door is left open for them to leave they won't take the chance
out of fear. A change that would break someone out of a depression who is in
an impossible situation could just as easily end up in what could be called a
psychotic break. Hurting themselves or someone else, thereby becoming free of
the situation by being in jail.

I'd like to add that part of the solution to help those particular cases could
be to promote a society of helpfulness. To know if they jump from that life,
work or situation that they won't die or have to crawl back to their abusive
trap.

There isn't an answer and I think that you should err on the side of caution
by not being dismissive of depressed people. There could be something in their
life making them unhappy but they probably can't find any healthy way out.
Without anti-depressants many people self medicate with alcohol for instance
which I would argue is a worse condition to exist in.

Anyway that is a lot of rambling to say there isn't a clear answer so please
think twice before dismissing depression. Invisible diseases are incredibly
difficult to live with for the very reason they aren't visible in a photo.

~~~
ufo
Depression is more about lack of motivation than it is about lack of
happiness.

------
ruffrey
> The most common treatments for depression were antidepressants (87.0%),
> followed by psychotherapy (23.2%), anxiolytics (13.5%), antipsychotics
> (7.0%), and mood stabilizers (5.1%).

As a former therapist turned software engineer, herein lies the problem. 87%
antidepressants? How are we defining "treatment?" Depression is a complex
beast, and does it always require "treatment"?

I had a kid with my wife (together 10 years) about 15 months ago. Our little
guy slept like absolute shit until a month ago, awaking multiple times per
night, every.single.night. Nothing changed this; he finally grew out of it. We
also moved, remodeled our home, and became a little isolated. I have suffered
depression, including a period of hospitalization early on, dabbled with
antidepressants, etc since adolescence. Never had psychosis, as I am lucky. I
worked as a therapist for many years. I know this stuff. Yet due to
psychosocial stressors, I fell into a period of depression for a couple
months. The poor sleep mixed with isolation due to moving, and less exercise,
probably. Gained 20 lbs. I know better, I know my triggers, I know warning
signs, but it happened. Antidepressants would have masked the issues here. The
side effects are subtle but serious over time. And they don't fix the problem
for people with my kind of depression. Yet, my primary care doc would have
prescribed antidepressants in a heartbeat. That is a serious problem with the
medical system in the US.

What is "treatment"? Sleep, exercise and social experiences? Is there a way to
measure that reliably and accurately? Probably not; that is why I take
articles like this with a big grain of salt.

~~~
aantix
On a slightly related note; with all of your life changes, it's pretty easy to
become Magnesium deficient. Please look into taking Magnesium Glycinate. It's
made a world of difference in my depression. (just make sure you're taking at
least 1,000mg a day, two capsules every 4-6 hours).[1][2][3][4]

[1]
[http://www.ncbi.nlm.nih.gov/pubmed/16542786](http://www.ncbi.nlm.nih.gov/pubmed/16542786)

[2]
[http://www.ncbi.nlm.nih.gov/pubmed/19944540](http://www.ncbi.nlm.nih.gov/pubmed/19944540)

[3]
[https://examine.com/supplements/magnesium/#summary3-7](https://examine.com/supplements/magnesium/#summary3-7)

[4] [https://www.amazon.com/KAL-Magnesium-
Glycinate-400-tablets/d...](https://www.amazon.com/KAL-Magnesium-
Glycinate-400-tablets/dp/B00013YZ1Q/)

~~~
PragmaticPulp
While there's no harm in supplementing with small doses of Magnesium, it's
also very unlikely to be the sole causative or curative factor in most
people's depression. I'll address your studies individually:

[1] Refers to case studies (e.g. clinical anecdotes) of depression recovery
following magnesium administration, but the number of cases is omitted. More
importantly, there are no placebo controls to differentiate between
spontaneous or placebo response and response to the magnesium supplementation.
Finally, the article is in the context of severe magnesium deficiency, which
is a strong selection bias that prevents the anecdotes from being extrapolated
to the general population anyway. (Yes, I am aware that much of the US
population does not meet FDA guidelines for magnesium intake, but that's not
the same as being deficient in magnesium in the body).

[2] Is a good example of the importance of noting which journal the article
was published in: In this case, it was published in Medical Hypotheses, which
is dedicated to promoting diversity in debate by publishing hypothesis and
fragmentary ideas that don't yet have enough real evidence to publish
elsewhere. The first study it cites is from 1921, which was not placebo-
controlled. The second study cited is from a journal dedicated to Magnesium
research, but more importantly which _pre-selected for patients with
hypomagnesia_. In other words, the study examined whether Imipramine (an anti-
depressant) or magnesium supplementation were more effective in elderly type 2
diabetes patients who were known to have hypomagnesia.

[3] Refers to animal studies, but 3 of the 4 cited articles are about
magnesium in migraine headaches. Perhaps the full-text articles have some
embedded murine studies, but otherwise I don't see much evidence for magnesium
treatment in humans here.

In short: It can't hurt to supplement, but it's unlikely to be curative. More
importantly, recommending weak or unproven supplements to depressed patients
can send them down a path of attempted self-medication with supplements that
do not work, when proper medical treatment can work much more quickly and
effectively.

~~~
aantix
I don't think I ever made the claim that Magnesium would cure. It has helped
my symptoms. Hypermagnesemia appears to be very rare so it was a low risk
effort for me. I've had positive results with it whereas other touted natural
antidepressants have quickly petered out (St John's Wort, 5-HTP).

------
thom
I scrolled down to the bottom of the page, and there's a little ad to
subscribe to Scientific American 'Mind' magazine. One of the issues has 'How
to Raise a Happy Child' across its front page, 'The essential guide to
improving kid behaviour and resilience'.

That pretty much sums up the impression I get from American attitudes to
parenting and early childhood. Behave, be resilient, and when the time comes,
take your measly week of parental leave to teach your baby to behave and be
resilient too.

Prevention is better than cure: the traumas of early childhood sow the seeds
for a lifetime of anxiety and unhappiness. I don't really believe there is a
long term solution to widespread mental health issues without concentrating on
that fact, and enabling parents to provide the love, bonding and security
their children require. But instead, in the US and here in the UK, we make
parents' lives harder and harder (especially those in low paid jobs or out of
work) and assume that an online course of CBT in a few decades will mop up any
problems.

~~~
alanwatts
The family unit has been anything but since the industrial age.

For ~99% of human history, families lived, learned, and worked closely
together.

As of late, the opposite is now true. How can parents provide adequate love
and bonding to their children when they both spend the majority of their time
separated from each other with strangers at school/work?

~~~
Noseshine
What's more, not just the family as a small group, but also the larger groups
of many families and generations remaining close and connected. Today with so
many people moving around the country and even the world (me, for example, the
latter as well as the former), those close networks just don't exist any more.

------
tombert
"Some groups, such as men and adults with less education, as well as ethnic
and racial minorities, were especially unlikely to receive any treatment for
their depressive symptoms"

I know that when I was making less money and had worse insurance, I never have
even considered getting any kind of treatment for my depression. Me feeling
bad and hating everything was something I felt I could deal with, and it took
a low priority over pretty much everything else.

~~~
Joof
Unsurprising. It's expensive. Of course, you probably needed it more when you
didn't make much.

Being unemployed is a huge risk factor for depression, but when unemployed how
do you afford treatment?

------
mkane848
Are more adults depressed, or are we just noticing it more? I can't tell if
we're hitting the next phase of "just give the kids adderall" or if this is
actually a problem with US society right now. The current popular jokes all
revolve around hating your life and killing yourself, it's kinda strange.

~~~
samatman
While there are many factors, I'm convinced that our most popular social media
platforms, Facebook in particular, cause depression.

It's anecdotal, but when I stay off FB I feel better about life. When I
compulsively browse for hours, I feel terrible about myself, my friends, and
the state of the world.

Intriguingly, Facebook has started doing sentiment analysis, putting them at
risk of discovering with statistical rigor that their product causes
depression. If so, their position right now is no different from the tobacco
companies, in that they know that they're making their users sick.

------
cbognet
I studied neuroscience in college, so have tried to stay up to date on what we
know about the biology of things like anxiety and depression (surprisingly, we
know very little for sure). The "chemical imbalance" hypothesis that I was
taught in college and that is widely accepted is increasingly being
challenged. For example, is it possible that depression is a symptom of a
larger inflammatory problem vs. its own disease? Inflammation caused by stress
or undiagnosed food or environmental allergies? (People with allergies have a
higher risk of depression and suicide, especially in the spring. Allergy shots
can help.)

In terms of non-pharmaceuticals, here's what seems to be effective: B Complex
vitamins (make sure to get methylcobalamin form of b12 included not cyano),
sleep, meditation, exercise, social support, omega 3, vitamin D, probiotics
(refrigerated, not gummy), not taking NSAIDS, not taking proton pump
inhibitors or antacids, low carb/very little sugar.

~~~
AstralStorm
Please provide sources for the more interesting / outrageous claims.
Especially meditation, probiotics, PPIs link to depression or the specific low
sugar diet. Good quality controlled trials on more than two handfuls of
people.

------
benevol
One of my best friends was able to drop his dependency on anti-depressants
(which _are_ a bitch) with 1 well prepared and well managed LSD experience (he
had made 100% sure that the substance was indeed LSD and that the quality was
the purest possible, spend tons of time researching every aspect). His
experience was apparently so profound that he was able to stop all meds and
since then never touched them again ( _remaining_ free from depression).
Obviously, 1 dose of LSD costs virtually nothing, compared to anti-depressant
prices (long-term usage), which may be one of the reasons it is not being
pushed by the pharmaceutical lobbying powers that be. There's also a
(real/licensed) doctor in Switzerland who has researched this substance/field
very successfully.

Meditation is also very often mentioned for (not deeply/clinically) depressed
people, as well as the Wim Hof Method.

EDIT: The case of the above mentioned person needs the following PSA: LSD is
not for everyone: if you have anybody in your family who suffers from
schizophrenia or psychosis, you may have this potential as well, which means
LSD could trigger a crisis (but not cause the medical condition itself).

~~~
greenshackle
My friend took LSD and it made her anxiety worse. Another got an epileptic
seizure while on LSD (never had one before or since the trip).

Not to say you shouldn't try it, I know several people who had positive
experiences, but it's not 100% positive, as some people make it out to be.

(in before 'oh what they took wasn't actually LSD' from the 'LSD can do no
harm' crowd)

~~~
oxide
just like heroin laced or replaced entirely by fentanyl, there are plenty of
unsavory cats ordering NBoME or other compounds online and passing it off as
LSD.

harm reduction circles _always_ recommend testing the drugs yourself with a
reagent kit, easily acquired online, because otherwise there is absolutely no
way to know what was ingested.

not saying your friend didn't take LSD, nor am I naive enough to think LSD
does no harm, just that if your friend didn't test the tab themselves, they
have no idea what they took. unless they personally know the chemist, I
suppose.

------
fallingfrog
I don't buy it. Something else is going on. Look: Pretty much everybody I know
is on antidepressants. Are we really facing a massive epidemic of sudden
chemical imbalances? _Everybody_. I propose that our brain chemistry is
unchanged, and unless you want to redefine normal in such a way as to exclude
the entire current human population, the problem here is not medical.

~~~
Jtsummers
The problem _is_ medical, it's also societal. The solution is _not_ chemical,
but antidepressants are effective (for many people) in alleviating their
symptoms.

Loneliness -> Depression for many people. Stress -> Depression for many
people. The solution is to address those. What causes you stress, can you
alleviate it, can you change your circumstances. What causes your loneliness.
Can you move somewhere else, can you meet other people and develop a social
life.

There is a (probable) chemical imbalance for most of these people, but the
cause is not the chemical imbalance, it's the emotional/physical/mental
stressors. They're what need to be addressed for long term recovery.

EDIT: I should amend this. _Some_ cases of, particularly the severe cases,
anxiety and depression are the result of an actual chemical imbalance where
addressing concerns like the above won't help. In those circumstances,
medication is certainly appropriate and probably necessary.

~~~
rak00n
I saw this TedTalk[0] earlier that vouches this idea. The genes we got from
our hunterer gatherer ancestors cannot sustain sedentary isolated life we live
today.

[0]
[https://www.youtube.com/watch?v=drv3BP0Fdi8](https://www.youtube.com/watch?v=drv3BP0Fdi8).

------
pasbesoin
Health care in the U.S. is not about health care. It's about wealth transfer.

1\. People don't get effective treatment. 2. People start avoiding the system
and its giant suck, even when it is to their detriment. It becomes difficult
to discern whether this detriment is greater than that of "participating".

------
PaulHoule
I would hold off on the hating on antidepressants.

Benzodiazepines, popular for anxiety, impair cognition, learning and memory
and get in the way of the natural process of learning how to deal with life
better and thus feel better.

Antidepressants do not. Antidepressants have an additive effect with
psychotherapy, exercise, meditation, stress reduction, etc.

Also in cases of chronic pain where somebody is taking an NSAID or
acetaminoprophen daily, many of those people would be better off taking an
SNRI like Effexor.

------
6stringmerc
> _Nearly three-quarters of patients who were treated for depression were
> treated exclusively by general medical professionals, and those patients
> were less likely than patients treated by psychiatrists or other mental
> health professionals to have screened positive for depression or serious
> psychological distress._

I tend to see this kind of anecdote (data inference?) as a strong rebuttal to
those who claim "Oh in the US it's not just like here, have a pill and you'll
feel better!" when the people handing out the pills aren't specialists in the
field where they're dealing out psychoactive substances. Would clamping down
on the ability for 'general practitioners' to write scripts for stuff like
this maybe help move the needle back into more rigorous treatment plans? Would
it just cut off access to the drugs that otherwise help? Lots of implications
to untangle, and I'm sure the pill industry wouldn't be really game to start
making things more difficult...

------
ufo
One thing that I find worrying about this comment thread is how there is a
general vibe of "antidepressants are evil". This widespread idea makes a lot
of people who should be seeking treatment be reluctant to do so and as the
article points out, right now under-treatment is a much bigger problem than
over-treatment.

If you are feeling depressed you really should seek help from a psychiatrist.
Having a face-to-face appointment with a psychiatrist will put you on a much
better position to find out if you should be prescribed antidepressants or not
(as well as other forms of therapy).

------
barking
Is it possible that to be clinically depressed (on the milder end of the
scale, perhaps) for years and be unaware of the fact?

~~~
Broken_Hippo
Very much so. For example, Dysthymia
([https://en.wikipedia.org/wiki/Dysthymia](https://en.wikipedia.org/wiki/Dysthymia))
often goes untreated. Some people develop this at a really young age, and
simply don't know any differently. It seems that Atypical depression
([https://en.wikipedia.org/wiki/Atypical_depression](https://en.wikipedia.org/wiki/Atypical_depression))
can probably result in the same unawaredness, due to having positive feelings
to positive situations.

------
lutusp
It's important to say that the primary treatment for depression (87% of cases)
is drugs, and it's now established that available drugs do not work. A now-
famous series of meta-analyses
([http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/))
that include unpublished drug studies show that, for the majority of clients,
drug therapy shows no clinically significant benefit.

So when we read that the majority of depressed people aren't being treated,
it's vital to remember that the majority of _treated_ people aren't being
treated either. The very real possibility exists that we have no idea how to
either diagnose or treat depression.

------
mjevans
Adults are screened for anything? When does this happen?

(Asked in a joke-like manor, but I am being serious, I can't recall EVER
having been screened and don't feel like I'm an outlying case. How many
haven't been forced to be tested?)

------
testosthrow
I'll just say something that might help the lads here. Get your testosterone
levels checked. Sitting around, getting extra weight, my T levels were good...
for a 90 year old. I've always had the "mind over matter" thing, looked down
on manliness and testosterone, etc. Total nerd stereotype. I was so damn
wrong.

So I read up on it and decided to take the plunge. The difference was immense.
I feel so much more alive. Not even working out, I'm losing weight and getting
stronger. It's the cheapest drug I've taken for the hugest effect. Everyone
that knows me has commented, even when I was only 2 weeks in.

~~~
AstralStorm
Please do not offer medical advice of this kind. While it is true that lack of
testosterone can mimic some symptoms of depression (much less than low thyroid
hormone for example, which should be checked first, it is not uncommon), the
treatment has almost the same side effects as with any steroid hormone and the
disorder is quite taste.

------
greendata
Part of the problem is that the cost of therapy, and all medical care, is
skyrocketing in the US. We're working on lowering the cost with online
therapy. We use a break-fix model where you only pay if we help fix your
issues.

[http://cheeseburgertherapy.com](http://cheeseburgertherapy.com)

------
dbg31415
Untreated meaning what? Un-medicated? I don't see that as a bad thing. The
cause of depression is seldom one that medication alone can overcome.

Therapists... they're probably useful for some people.

For others, man what they wouldn't give to just have a few more friends, or
something to do / some place to go where they felt welcome and needed.
Medication doesn't help give people purpose or cure the underlying behavior
that prevents them from building friendships.

This is a complicated thing, since there's no guaranteed cure for everyone,
there's no reason to be concerned if people seek different ways to combat this
deeply personal problem they face.

Some generic advice... eat healthy, get some exercise in the sun, keep your
room clear from distractions (tv / laptops / cellphones) so you can sleep...
just do the best you can. One foot in front of the other. Try and be social if
you have the energy for it.

~~~
Broken_Hippo
Untreated means that there aren't therapists nor medications for the person.

I agree that therapy isn't for everyone. However, some people are truly helped
by therapists, especially if they are lacking life skills or coping
mechanisms.

Those people that just want to have a few more friends or something to do
where they are accepted? Well, medicine can help with that at times, depending
on the situation. If they don't have friends because they work too much, and
can't go places because of money or disability, the medication won't help them
solve those things. The crappy thing is, however, is that some folks that are
depressed long for these things, but they can't get out from under the fog
enough to actually do anything about it. Medication often clears up the fog
enough to be a productive person.

It is a complicated thing. It isn't a problem if people seek different ways,
but that should include being ok with folks taking medication.

Your generic advice? Honestly, it just doesn't work for a lot of people with
depression. Eating healthy and exercise is great if you have the motivation to
do it: Not so sound advice if you can barely get the energy up to have clean
clothing. _One damning effect of depression is an absolute void of motivation
to do anything_ What do you do if the distractions keeping you from sleeping
are the thoughts in your head? _Rumination and worry is a horrible thing_ They
already are doing the best they can just by barely making it through a
workday. Try and be social with a depressed and warped view of the world?
That's a mighty difficult thing to strive for.

The whole point is that if it were possible to just do a few simple things and
think or act your way to happiness, it'd not be such an issue. But not
everyone can even get to that point.

~~~
dbg31415
Listen, without getting into too much detail, the root of solving depression
is always the realization that you aren't powerless and you aren't worthless.
You can do things, you can improve, you can add value to the lives of others,
you can have the life you want... small steps get you there.

Letting yourself get into that rut, that dark space, it's very hard to get out
of that. Medication, friends, therapy, success... if you're convinced you are
worthless and that there's no point to anything... it won't matter what you
have going since you won't see it.

Avoiding that, through some simple activities, is what I think is helpful. The
focus of "curing" depression has to be preventing yourself from falling back
into it.

And get a dog. They love you, they force you to get some exercise, and you
always feel small accomplishments being able to take care of them.

------
CptJamesCook
They forgot to mention the corollary: most treated adults remain depressed.

------
lallysingh
Note: Most [of] Depressed Adults in the U.S. Remain Untreated.

Not how I initially read it: [The] Most Depressed Adults in the U.S. Remain
Untreated.

~~~
johnchristopher
I know, right ? I am not a native speaker and more often than not I can't
figure out how to interpret such short titles, especially when it throws
grammar out of the window in order to get something shorter. And yet they
chose to take special care and went on capitalizing some words.

------
whatnotests
How very depressing.

