11 ms·

Most Depressed Adults in the U.S. Remain Untreated

98 points by aburan28 10y ago

pasbesoin 10y ago
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".
cbognet 10y ago
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 10y ago
  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.
PaulHoule 10y ago
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.
thom 10y ago
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.
- fil_a_del_fee_a 10y ago
  "the traumas of early childhood sow the seeds for a lifetime of anxiety and unhappiness." VERY well said!
- alanwatts 10y ago
  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 10y ago
    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.
dbg31415 10y ago
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 10y ago
  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.
sosuke 10y ago
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 10y ago
  Depression is more about lack of motivation than it is about lack of happiness.
whatnotests 10y ago
How very depressing.
lallysingh 10y ago
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 10y ago
  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.
tombert 10y ago
"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 10y ago
  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 10y ago
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.
- k-mcgrady 10y ago
  >> "Are more adults depressed, or are we just noticing it more?" Not sure if it's a good indicator but suicide rates seem to have jumped massively in the last 10-15 years.
- mjevans 10y ago
  I suspect that, at least in today's society, we have more to be depressed about. Sometimes you're feeling bad about the world because the world's relationship with you is crummy, not because you're broken your self.
- randomgyatwork 10y ago
  Some people I know have 'depression', really they are miserable about their work and lives. They tell the doctor their problems, the doctor jumps on giving them drugs. Realistically, if they changed their jobs they'd probably be more happy, but drugs is the default solution.
- samatman 10y ago
  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.
ruffrey 10y ago
> 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 10y ago
  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/dp/B00013YZ1Q/ https://www.amazon.com/KAL-Magnesium-Glycinate-400-tablets/d...
  - PragmaticPulp 10y ago
barking 10y ago
Is it possible that to be clinically depressed (on the milder end of the scale, perhaps) for years and be unaware of the fact?
- DanBC 10y ago
  Yes. Good clinicians should be trying to recognise subthreshold symptoms and providing advice. https://www.nice.org.uk/guidance/qs8 https://www.nice.org.uk/guidance/qs8 > This quality standard covers the assessment and clinical management of persistent subthreshold depressive symptoms, or mild, moderate or severe depression in adults (including people with a chronic physical health problem).
- johnchristopher 10y ago
  Unfortunately, yes.
- Jtsummers 10y ago
  Yes. The worst part, for me, with depression is that my actions and beliefs were actually entirely rational during those periods. But the premises of my beliefs were false. Think of an axiomatic system for math, but add in 2+2=5. You can draw some interesting conclusions from such a system, but the basic premise has a critical flaw. Internally, you don't see it. You only see it from the outside.
- Broken_Hippo 10y ago
  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.
fallingfrog 10y ago
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.
- DanBC 10y ago
  > sudden chemical imbalances? Nobody credible believes the chemical imbalance stuff anymore. That doesn't make depression any less real - the fact that more people have a diagnosis might mean that a bunch of people who had unmet need are now getting the treatment they deserve.
  - AstralStorm 10y ago
    It might well be chemical imbalance, but like most chemical systems in the body, it is probably a symptom.
- Jtsummers 10y ago
  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 10y ago
empath75 10y ago
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.
- mklim 10y ago
  The fundamental problem is how cripplingly little we understand about neurobiology. "Depression" is a label given for a common cluster of symptoms, not a single disease originating from a few well-understood causes. We aren't able to objectively test for or treat it the way we can X-ray a broken bone and set it or swab a throat for strep and prescribe antibiotics. There are no methods that are guaranteed to help the vast majority of sufferers and no clear understood root causes. All we can do is ask for the patient to report their subjective experiences and try to tick some boxes in the DSM, find a label that describes at least N/N+M of their symptoms, and then work through an associated checklist of wildly different methods of "treatment" that reduce symptoms in some, but not all (or even a majority, AFAIK) of patients. I personally think that many (if not most) of the mental illnesses listed in the DSM will eventually be understood to be multiple completely unrelated root conditions that all manifest similar symptoms, each with different methods of treatment. Unfortunately research initiatives tend to be shackled to the DSM's set of superficial symptom groupings in order to get funding, so a deeper understanding of them is probably a long time coming. (Related read: http://www.theatlantic.com/health/archive/2015/08/why-depression-needs-a-new-definition/399902/ http://www.theatlantic.com/health/archive/2015/08/why-depres...)
  - 10y ago
mjevans 10y ago
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?)
6stringmerc 10y ago
>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...
benevol 10y ago
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 10y ago
  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 10y ago
    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.
- tcj_phx 10y ago
testosthrow 10y ago
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 10y ago
  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.
lutusp 10y ago
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.
greendata 10y ago
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
ufo 10y ago
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).
pravda 10y ago
This is what is known on HN as a 'Submarine' article [1]. This article 100% bought and paid for by the very talented flacks working for big pharm! [1] http://www.paulgraham.com/submarine.html http://www.paulgraham.com/submarine.html
CptJamesCook 10y ago
They forgot to mention the corollary: most treated adults remain depressed.

98 points by aburan28 10y ago

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".

cbognet 10y ago

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 10y ago
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.

PaulHoule 10y ago

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.

thom 10y ago

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.

fil_a_del_fee_a 10y ago
"the traumas of early childhood sow the seeds for a lifetime of anxiety and unhappiness." VERY well said!
alanwatts 10y ago
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 10y ago
  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.

dbg31415 10y ago

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 10y ago
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.

sosuke 10y ago

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 10y ago
Depression is more about lack of motivation than it is about lack of happiness.

whatnotests 10y ago

How very depressing.

lallysingh 10y ago

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 10y ago
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.

tombert 10y ago

"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 10y ago
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 10y ago

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.

k-mcgrady 10y ago
>> "Are more adults depressed, or are we just noticing it more?" Not sure if it's a good indicator but suicide rates seem to have jumped massively in the last 10-15 years.
mjevans 10y ago
I suspect that, at least in today's society, we have more to be depressed about. Sometimes you're feeling bad about the world because the world's relationship with you is crummy, not because you're broken your self.
randomgyatwork 10y ago
Some people I know have 'depression', really they are miserable about their work and lives. They tell the doctor their problems, the doctor jumps on giving them drugs. Realistically, if they changed their jobs they'd probably be more happy, but drugs is the default solution.
samatman 10y ago
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.

ruffrey 10y ago

> 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 10y ago
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/dp/B00013YZ1Q/ https://www.amazon.com/KAL-Magnesium-Glycinate-400-tablets/d...
- PragmaticPulp 10y ago

barking 10y ago

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

DanBC 10y ago
Yes. Good clinicians should be trying to recognise subthreshold symptoms and providing advice. https://www.nice.org.uk/guidance/qs8 https://www.nice.org.uk/guidance/qs8 > This quality standard covers the assessment and clinical management of persistent subthreshold depressive symptoms, or mild, moderate or severe depression in adults (including people with a chronic physical health problem).
johnchristopher 10y ago
Unfortunately, yes.
Jtsummers 10y ago
Yes. The worst part, for me, with depression is that my actions and beliefs were actually entirely rational during those periods. But the premises of my beliefs were false. Think of an axiomatic system for math, but add in 2+2=5. You can draw some interesting conclusions from such a system, but the basic premise has a critical flaw. Internally, you don't see it. You only see it from the outside.
Broken_Hippo 10y ago
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.

fallingfrog 10y ago

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.

DanBC 10y ago
> sudden chemical imbalances? Nobody credible believes the chemical imbalance stuff anymore. That doesn't make depression any less real - the fact that more people have a diagnosis might mean that a bunch of people who had unmet need are now getting the treatment they deserve.
- AstralStorm 10y ago
  It might well be chemical imbalance, but like most chemical systems in the body, it is probably a symptom.
Jtsummers 10y ago
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 10y ago

empath75 10y ago

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.

mklim 10y ago
The fundamental problem is how cripplingly little we understand about neurobiology. "Depression" is a label given for a common cluster of symptoms, not a single disease originating from a few well-understood causes. We aren't able to objectively test for or treat it the way we can X-ray a broken bone and set it or swab a throat for strep and prescribe antibiotics. There are no methods that are guaranteed to help the vast majority of sufferers and no clear understood root causes. All we can do is ask for the patient to report their subjective experiences and try to tick some boxes in the DSM, find a label that describes at least N/N+M of their symptoms, and then work through an associated checklist of wildly different methods of "treatment" that reduce symptoms in some, but not all (or even a majority, AFAIK) of patients. I personally think that many (if not most) of the mental illnesses listed in the DSM will eventually be understood to be multiple completely unrelated root conditions that all manifest similar symptoms, each with different methods of treatment. Unfortunately research initiatives tend to be shackled to the DSM's set of superficial symptom groupings in order to get funding, so a deeper understanding of them is probably a long time coming. (Related read: http://www.theatlantic.com/health/archive/2015/08/why-depression-needs-a-new-definition/399902/ http://www.theatlantic.com/health/archive/2015/08/why-depres...)
- 10y ago

mjevans 10y ago

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?)

6stringmerc 10y ago

>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...

benevol 10y ago

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 10y ago
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 10y ago
  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.
tcj_phx 10y ago

testosthrow 10y ago

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 10y ago
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.

lutusp 10y ago

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.

greendata 10y ago

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

ufo 10y ago

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).

pravda 10y ago

This is what is known on HN as a 'Submarine' article [1]. This article 100% bought and paid for by the very talented flacks working for big pharm! [1] http://www.paulgraham.com/submarine.html http://www.paulgraham.com/submarine.html

CptJamesCook 10y ago

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