There's a lot of talk about how Americans are "overmedicated." Doctors say patients are often not satisfied if they leave the doctor's office without a new bottle of pills. But a lot of us are undermedicated, and the impact on public policy, as well as individual lives, is enormous.
More than 16 percent of Americans - up to 35 million men and women - suffer from clinical depression and many of them could be dramatically helped by new drugs. But the Journal of the American Medical Association reports that only 60 percent of those in treatment receive adequate meds. We're talking about men and women already in treatment.
There are many reasons why this is happening, but the most significant finding in this study by the National Institutes of Health is that family doctors don't know enough about current antidepressant drugs to prescribe them properly. Dosages are often too small to help. Many patients have a prejudice against these drugs and it adds up to trouble. Researchers estimate that untreated depression costs employers more than $31 billion a year. Most depressed workers make it to the job but many perform poorly.
Depression is an equal opportunity psychiatric illness, striking young and old, black and white, men and women. Like almost everything else, it hurts the poor most of all. Four times as many of the poor suffer from chronic depression. The poor make fewer visits to the doctor's office and depression is sometimes overlooked as "just life," not a medical problem.
The researchers found that three times more young people between the ages of 18 to 29 suffer from depression than people over 60. But in my research for a book about aging, I've found that depression is often overlooked in the elderly by family doctors, members of the family and by the seniors themselves. Everyone is likely to consider depression the consequence of the aging process, not a clinical, and treatable, disorder.
One man of my acquaintance is typical. His father, a Baptist preacher, suddenly lost interest in everything as he approached 70. "Dad was always ready and eager to talk about spiritual things," his son told me. "His mind was full of interpretations of scripture, for example, but in his declining years, I couldn't even spark an interest in the Bible. He only wanted to lie on his bed, staring at the ceiling. I tried to imagine what was going on in that once quick and nimble mind.
"'Tell me, Pop,' I would say, 'what was the lesson of the story of Abraham and Isaac,' or 'what exactly did Christ mean when he said that we are joint heirs with Him to the kingdom of God?'
"In the old days his eyes would have come alight and he would have treated me with a Bible lesson to have delighted a lecture hall full of scholars. But not when he grew older. 'Look it up,' he said flatly. 'You'll find it in one of my books by Spurgeon or B.H. Carroll.'"
When a doctor suggested that the preacher see a psychiatrist, the son balked. Both son and father saw depression as a weakness and getting help as an indulgence. A psychiatrist finally persuaded them to give a new drug a try. Within a few days the preacher began to relish questions once more: "Now, about Romans 8:17."
My own father suffered a severe bout of depression when he was in his 70s and the family doctor treated it with talk "therapy." I had edited a mental health journal for the National Institutes of Mental Health and knew about the new drugs. I told his doctor that I thought certain drugs might help.
The doctor ignored my pleas until I hand-delivered a letter to his office suggesting that a malpractice suit might get his attention if he didn't look into medication for my father. He referred Dad to a psychiatrist, who put him on medication and within a fortnight his old zest for life was back.
He went on to enjoy a decade of hanging out with his buddies at the local deli, the race track, and trading stories about the good ol' days. Dad and my mom resumed their Wednesday lunch dates at a favorite restaurant, walking down the street holding hands.
Of course this is merely anecdotal evidence of the kind often scorned by science. Drugs don't always work and they can have some bad side effects. But when they're right and provided by a knowledgeable doctor, they can make a huge difference. My father joked that his psychiatrist was a "drug pusher." But the medications transformed him. In kicking depression, he got high on life. Others can, too.