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hi all once again here is another news article on clinical depression. i don't think we can get too much information on it [clinical depression = cd ?] it's something i've been wrestling with for a number of years [currently assisted by prozac] probably or even certainly linked to my pd but also probably linked to my family background where i believe my mother suffered with cd but at the time [mid 1950's] was undiagnosed and untreated if her cd had been treated the last 9 years of her life [she died in 1964] would have been transformed and wouldn't have been her last i believe that many people still confuse 'sadness' and 'depressed feelings' with clinical depression and, as a result, cd doesn't get the respect that it deserves i sent the following comments today to a friend in re another subject, but i think they apply here too: >and men >in general >still are not supposed to display any 'weakness' > >and society >in general >still regards emotional issues as secondary to rational ones in addition, i have read studies that indicate that as many as 40 to 50% of all parkies have cd as well. i love the pd battle cry of "invisible no more!" if i have pd *and* cd do i get to yell it twice? janet ---------------------------------------------------------------------- Aid for the depressed seen lagging ---------------------------------------------------------------------- Copyright 1997 Nando.net Copyright 1997 N.Y. Times News Service (Jan 22, 1997 01:18 a.m. EST) - There is a perception in some circles that everyone either is taking an anti-depressant or knows someone who is taking one. Prozac and Zoloft are household words and the sales of these drugs have soared to the point where the global market for all anti-depressants is estimated at $6 billion a year. But at the same time a panel of experts recently concluded that depression was still being underdiagnosed and undertreated. For most people with clinical depression, the disorder is either undiagnosed or misdiagnosed, the panel reports in the current issue of The Journal of the American Medical Association. Of those who have been depressed for 20 or more years, about half have never taken an anti-depressant, the report says, and fewer than one-third of those who take medicine get an adequate dose for a long enough time. What is most surprising about the findings is that they come from studies done after Prozac, the first of a new generation of anti-depressants, came into widespread use. These drugs, selective serotonin re-uptake inhibitors, increase the brain's level of serotonin, a neurotransmitter that influences mood. Not only are they safer than their predecessors, they have achieved a certain celebrity status, factors that doctors say have made them more acceptable to patients and doctors. "I would have believed that the vast majority of people with chronic depression would have been treated and treated better," said Dr. Martin B. Keller, a panel member and chairman of the department of psychiatry and human behavior at Brown University School of Medicine. "I was almost horrified." While some psychiatrists who were not on the panel found the report overly pessimistic, they agreed with its overall conclusions. "There's no question that depression is still underdiagnosed," said Dr. T. Byram Karasu, chairman of the department of psychiatry at Albert Einstein College of Medicine in New York City. The National Depressive and Manic-Depressive Association, a professional group in Chicago, convened the panel last year to examine the gap between the knowledge and treatment of depression and to find out why it exists. Panelists for the conference included psychiatrists, family doctors, patients and representatives of insurance companies. Their lodging and expenses were paid for by Bristol-Myers Squibb, the manufacturer of Serzone, an antidepressant. The panel estimated that 24 percent of women and 15 percent of men would suffer from clinical depression at some point in their lives. The annual cost of the illness was placed at $43 billion in medical expenses, absenteeism and lost productivity at work and premature death. One of the biggest obstacles to diagnosis and treatment is people's attitudes toward their symptoms, the panel said. Some people mistakenly assume that being sad most of the time is an aspect of their personality or a normal response to a troubling situation. Others realize that they suffer from depression but do not seek help out of fear of being stigmatized at work or at home, according to the report. The panel reports that when patients are treated, many do not complete their drug therapy. Market research has found that half of all patients stop taking their medicine within 30 days because they are troubled by the side effects, which include nausea, insomnia and sexual dysfunction. But medical evidence indicates that depression requires long-term treatment to prevent relapse, Keller says. Another problem is that primary-care doctors often fail to recognize signs of depression in their patients, despite several recent education campaigns by the National Institute of Mental Health and other groups. The panel found that many doctors spent too little time with their patients to make a diagnosis, or that they dismissed the signs of depression as hypochondria. When doctors do prescribe anti-depressants, they often give too low a dose for too short a period in an effort to minimize side effects, the panelists said. Finally, the report concluded that limited mental-health insurance coverage was a major barrier to adequate treatment. Ninety-three percent of people with health insurance have mental-health benefits, said Eron Shosteck, a spokesman for the Health Insurance Association of America. But Keller said few plans approved psychotherapy for depression anymore because it was too expensive, leaving anti-depressants as the only treatment option. But he and his colleagues also found that some managed care plans discouraged doctors from prescribing the newer anti-depressants because they are more expensive than the older ones. "This is penny-wise and pound-foolish," said Dr. Robert M.A. Hirschfeld, head of the panel and chairman of the department of psychiatry and behavioral sciences at the University of Texas Medical Branch in Galveston. "Compliance with the newer agents is much higher because their side effects profile is more acceptable. If people don't comply with their medicine, there is a greater risk of relapse and suicide." The report did note some improvements. It said only about 10 percent of people with depression received adequate treatment in a 1980 study, but 27 percent did in a 1995 study. Some psychiatrists said the studies reviewed by the panelists were too old to reveal the full impact of the new anti-depressants. In the last 11 months of 1996, the market for all the selective serotonin re-uptake inhibitors grew 20 percent, said Sharyn Arnold, a spokeswoman for SmithKline Beecham, the manufacturer of Paxil, the newest of these drugs. Sven Borho, an analyst with Mehta & Isaly, a pharmaceutical-securities research firm in New York, estimated 1995 sales of all antidepressants worldwide to be $6 billion, with about 60 percent of those sales for the selective serotonin re-uptake inhibitors. Sales figures from the manufacturers of the three main such drugs, Prozac, Zoloft and Paxil, put the 1995 worldwide sales of those drugs at almost $3.9 billion. The numbers mean that more people are being treated for depression, said Dr. Gary Tollefson, vice president of the Lilly Research Laboratory in Indianapolis, an arm of Eli Lilly, the manufacturer of Prozac. "Our data show that many patients who are prescribed these agents are being newly treated, not just transferring from other treatments," he said. Hirschfeld pointed out that these people are a privileged few because they recognize their problem and have the means to treat it. He said that to reach most other people with depression would require efforts to reduce the stigma, educate doctors about diagnosis and treatment and expand insurance coverage. In other words, it will take a sea change greater than any drugs, however popular, can bring about. ----------------------------------------------------------------- [log in to unmask]