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Tuesday, January 12, 2010

Few Americans With Major Depression Receive Adequate Treatment

Image: Production of brain neurons (red) generated from adult neural stem cells (green) can alter brain activity patterns underlying depression.
Source of image:
"Many U.S. adults with major depression do not receive treatment for depression or therapy based on treatment guidelines, and some racial and ethnic groups have even lower rates of adequate depression care, according to a report in the January issue of Archives of General Psychiatry, one of the JAMA/Archives journals."

"Depression is a leading cause of disability among many racial and ethnic groups in the United States, according to background information in the article. Pharmacotherapy (including antidepressants) and psychotherapy are both effective, well tolerated treatments for depression when provided according to established guidelines (such as those from the American Psychiatric Association), the authors note. Previous research suggests that many individuals are untreated or undertreated, but most studies of depression care have not distinguished between the two modalities and have also aggregated major racial and ethnic groups (for instance, combining all Latino individuals instead of examining specific subgroups, such as Mexican Americans and Puerto Ricans)."

"Hector M. González, Ph.D., of Wayne State University, Detroit, and colleagues assessed the prevalence and adequacy of depression care among different racial and ethnic groups in the United States by analyzing data from the National Institute of Mental Health's Collaborative Psychiatric Epidemiology Surveys. This initiative combines three nationally representative studies, during which face-to-face interviews were conducted with 15,762 individuals age 18 and older throughout the country between 2001 and 2003."

"Of the adults surveyed, 8.3 percent had major depression, including 8 percent of Mexican Americans, 11.8 percent of Puerto Ricans, 7.9 percent of Caribbean blacks, 6.7 percent of African Americans and 8.5 percent of non-Latino whites."

"Overall, more than half of those with depression received at least one form of depression care, but only about one in five (21.3 percent) had received at least one form of therapy that conformed to established treatment guidelines within the previous year. Psychotherapy was more commonly used than pharmacotherapy, and individuals undergoing psychotherapy were more likely to receive treatment in alignment with clinical guidelines than were individuals taking medications."

Mexican American and African American individuals with depression consistently had lower odds of receiving any type of care or care in concordance with treatment guidelines during the year prior. "The proportions of Puerto Rican and non-Latino white individuals who used concordant therapies in the past year were nearly twice those of Mexican American, Caribbean black and African American individuals," the authors write.

The findings illustrate the importance of breaking down large ethnic and racial groups into smaller sub-categories, they note. "Failing to do so obscures depression care research, especially for the largest and fastest-growing segment of the U.S. population, Latino individuals, and especially Mexican American individuals."

"With the recent passing of a U.S. Mental Health Parity Act, our findings should provide guidance to better-enabled mental health to improve the depression care of all Americans and for reducing disparities among ethnic/racial minorities," they conclude."

"This work was supported by the National Institutes of Health National Institute of Mental Health and the National Institute on Aging."
This news article is just another example of a United States Health Care system in crisis.

According to the website to date, $1.05 trillion United States dollars have been allocated to the wars in Iraq and Afghanistan, and yet people who need medical care because they are depressed in the United States are not getting the care they deserve. Why is this? Are these people not visiting the doctor to get care, have these people no medical coverage, or it is for some other reason or reasons that they are not getting care for their depressive illness. Are these people not going to the doctor because they fear being stigmatized? 
Depression is an illness, just like AIDS or heart disease or cancer are illnesses, so why haven't adminstrators and those responsible for creating programs for these depressed people in the United States done something to help these citizens who have major depressive illness?? 

Depression causes brain damage, that is a fact! According to an article at the Boston Globe website:

" For decades, researchers struggled to identify the underlying cause of depression, and patients were forced to endure a series of ineffective treatments. But then came Prozac. Like many other antidepressants, Prozac increases the brain's supply of serotonin, a neurotransmitter. The drug's effectiveness inspired an elegant theory, known as the chemical hypothesis: Sadness is simply a lack of chemical happiness. The little blue pills cheer us up because they give the brain what it has been missing."

"There's only one problem with this theory of depression: it's almost certainly wrong, or at the very least woefully incomplete. Experiments have since shown that lowering people's serotonin levels does not make them depressed, nor does it worsen their symptoms if they are already depressed."

"In recent years, scientists have developed a novel theory of what falters in the depressed brain. Instead of seeing the disease as the result of a chemical imbalance, these researchers argue that the brain's cells are shrinking and dying. This theory has gained momentum in the past few months, with the publication of several high profile scientific papers. The effectiveness of Prozac, these scientists say, has little to do with the amount of serotonin in the brain. Rather, the drug works because it helps heal our neurons, allowing them to grow and thrive again."

"These discoveries are causing scientists to fundamentally reimagine depression."

Thank goodness for that!

"While the mental illness is often defined in terms of its emotional symptoms - this led a generation of researchers to search for the chemicals, like serotonin, that might trigger such distorted moods - researchers are now focusing on more systematic changes in the depressed brain."

"The best way to think about depression is as a mild neurodegenerative disorder," says Ronald Duman, a professor of psychiatry and pharmacology at Yale. "Your brain cells atrophy, just like in other diseases [such as Alzheimer's and Parkinson's]. The only difference with depression is that it's reversible. The brain can recover."

"Given the prevalence of depression - more than 16 percent of people will suffer from a major depressive episode at some point in their lives!!! - a more accurate scientific understanding of the disease is of immense value. In fact, this research is already being used to develop more effective treatments for the mental illness, some of which are currently in clinical trials."

"The progress exemplifies an important feature of modern medicine, which is the transition from a symptom-based understanding of a disease - depression is an illness of unrelenting sadness - to a more detailed biological understanding, in which the disease is categorized and treated based on its specific anatomical underpinnings."

Some of us  "have been told to snap out of it. Depression must be my fault, right?"

"Wrong. Depression is a medical illness which affects an organ, the brain, which in turn affects the rest of the body. One can no more snap out of depression that one can snap out of diabetes or heart disease. It would help to have a positive outlook, but the very nature of depression is a lack of positive outlook. Unfortunately, having depression still carries a stigma, though not nearly as bad as in the past. If there is any consolation, you are in good company: Winston Churchill, Abraham Lincoln, Peter Illych Tchaikovsky, Frederic Chopin, and Mike Wallace, just to name a few, all had crushing depressions."

"The risk of heart disease is doubled in people with depression, and a previous depression is often the greatest risk factor for heart disease and other ills, over smoking, drinking, high blood sugar, and previous heart attacks. Depression has also been connected to diabetes, bone loss, stroke, irritable bowel syndrome, and possibly cancer. In addition, people with depression have much higher rates of alcohol and substance use than the general population."

How is depression caused?

"The short answer is we don't know. It is convenient to say it is caused by a chemical imbalance in the brain, but this is not entirely accurate, especially since we cannot pinpoint the exact chemicals. The expert consensus is that depression is the result of genes, biology, and the environment interacting with one another. We have yet to identify depression genes, though experts expect we will find several, each making a small contribution. The biology largely concerns how neurons in the brain communicate to one another, and the chemical actions that take place inside the neuron, plus various stress pathways. The environment part of the equation includes personal stress and trauma. Various studies have shown that victims of childhood sexual abuse, war refugees, low income women, and the poor are far more depressed than the general population. While it is true that all these populations have more to be depressed about, these studies indicate a lot more is going on, here."

(source: ).

If most Severely depressed Americans are not receiving adequate treatment what about  people who have a depressive illness who live in other countries of the world?  According to the website: ,

"More than 50% of world population is suffering from depression, data suggests that the intensity of depression might vary, but more or less people between the age of 18-60 have symptoms of depression."

All I can say there is an awful lot of us out in the world who are suffering needlessly because we are not getting the treatment for our depression which we deserve to get from our health care systems!

Why did I include the image at the top of this blog entry? I did so for this reason:to give those readers who have major depression and their loved ones hope. This hope is due to new medical research which has come from  the Stanford University Medical Center in Palo Alto, California. Researchers there have issued a press release which states that they  "have identified one unifying principle that could explain how a range of causes and treatments for depression converge."

They found that in rats the differing mechanisms of depression and its treatment, in the end, appear to funnel through a single brain circuit. Changes in how the electrical signals spread through the circuit appear to be the cause of depression-related behavior, according to their study. Their findings were published  in the July 6,2007 issue of Science Express, the advance online publication of the journal Science.
"I think this will help us make sense of how there can be so many different causes and treatments of depression," said senior author Karl Deisseroth, MD, PhD, assistant professor of bioengineering and of psychiatry and behavioral sciences. "It also helps us understand conceptually how something that seems as hard to get traction on as depression can have a really quantitative, concrete basis."

"The work also may have implications for the search for new treatments for depression. "You can use that common pathway as the most efficient, most direct targeted way to find truly specific treatments," he said.

Deisseroth, who sees many depressed patients in clinic, said he has come to appreciate how the bumps in the road that most people see as normal obstacles in life become insurmountable hurdles to depressed people, causing them to lapse into helplessness.

"Reasoning that the brain is essentially a complex electrical circuit, Deisseroth's team set out to test the theory of whether brain circuitry malfunction could be at the root of depression. To explore the idea in a precise, quantitative way, they needed to develop a visualization tool that was faster and sharper than brain imaging systems currently available, such as MRI or CT scans."

"Raag Airan, an MD/PhD student in Deisseroth's lab and co-first author of the study, led the development of a technique called voltage-sensitive dye imaging for this model. This technique allows intact brain circuits to be viewed in real time, enabling the researchers to watch living neurons in action, across entire brain networks."

"The system uses a fluorescent dye, sensitive to brain circuit activity, which the researchers introduce into animal brain tissue. As dyed circuits light up and darken again in response to electrical activity, very fast high-resolution cameras capture the action. The researchers can observe how different stimuli received by the animal, such as a dose of an antidepressant drug, affect circuit operation.
The researchers used slices of rat brain, Deisseroth said, "like a computer repair technician would take out a circuit board" to test its functional properties. The brain slices, which remain active for many hours, came from parts of the hippocampus, a region long implicated in depression. They also tested slices from rats treated with the antidepressant medications fluoxetine and imipramine.

The team carried out the study using a standard rat model of depression. Even though the rats do not mimic the entire complexity of genetic and environmental causes of human depression, Deisseroth explained, the animals exhibit similar symptoms and also get better from the same medications that work on humans.
In these rats, they found an alteration in electrical activity flow through the brain that could be corrected by human antidepressants. The extent that the signal spread through the brain sample was diminished in the "depressed" rats, a crucial finding that would not be apparent with other experimental methods, Deisseroth said. They needed to be able to image a whole circuit simultaneously—and very rapidly—to see the effect."

"What surprised me most was how specifically the measure tracked the depression-related behavior," said Airan. "We usually think of psychiatric disorders as fuzzy and intractable, and this study showed me that, with the right tools, we could really put psychiatry on a quantitative framework."
Leslie Meltzer, neurosciences graduate student and co-first author, searched for the cellular basis of these changes in circuitry. An obvious place to start, she said, was to look at the formation of new neurons in the hippocampus, a process that neuroscientists have suggested is at the root of how antidepressants work. What they found was that the growth of new neurons could account for the behavioral improvements seen from treatment as well as the circuitry changes. The converse was not true: Fewer new neurons in that region did not equal depression.
In other words, in their model system, the two states appear to funnel through a common pathway—despite very different cellular mechanisms.
"The Holy Grail of psychiatry is to try to find final common pathways that can make sense of how genes and life experiences end up with the same result," said Deisseroth. "And the same goes for medications. There are many treatments that act in fundamentally different ways—how do we make sense of all that complexity?"
Deisseroth predicted that, as noninvasive imaging of human brains gets better in the next few years, researchers will be able to measure these same quantitative measures in people as well. "That will be a wonderful thing when that happens," he said."
It will only be a wonderful thing to my way of thinking if this imaging can be used to help those of us with a depressive illness regain our lives.

In closing if you want to see what a trillion dollars looks like click on the following link:


Depression Treatment said...

Depression is a devastating disease, one that strips its victims of their hope and joy and dignity. Depression treatment can help change the life style to a better living option for depressed victims.
Thanks for sharing nice information here.

Wayne said...

Your welcome. I hope that people who are depressed will consider visiting your website and if they live in the United States,they will call the number you provide at your website! Sometimes we humans need help from others in our lives,especially help from someone who knows alot about what we may be going through, and also knows why we might need help.

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Thoughts worth thinking about

"Our subconscious minds have no sense of humor, play no jokes and cannot tell the difference between reality and an imagined thought or image. What we continually think about eventually will manifest in our lives."-Sidney Madwed

Laws alone can not secure freedom of expression; in order that every woman and man present their views without penalty, there must be spirit of tolerance in the entire population.- Albert Einstein Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. - Leo Buscaglia

A person's true wealth is the good he or she does in the world. - Mohammed

Our task must be to free ourselves... by widening our circle of compassion to embrace all living creatures and the whole of nature and its beauty. -Albert Einstein

The best way to find yourself, is to lose yourself in the service of others. - Ghandi

The unselfish effort to bring cheer to others will be the beginning of a happier life for ourselves. - Helen Keller

Aim for success, not perfection. Never give up your right to be wrong, because then you will lose the ability to learn new things and move forward with your life. Remember that fear always lurks behind perfectionism. Confronting your fears and allowing yourself the right to be human can, paradoxically, make yourself a happier and more productive person. - Dr. David M. Burns

Life is as dear to a mute creature as it is to man. Just as one wants happiness and fears pain, just as one wants to live and not die, so do other creatures. -His Holiness The Dalai Lama

Mankind's true moral test, its fundamental test (which lies deeply buried from view), consists of its attitude towards those who are at its mercy: animals. And in this respect mankind has suffered a fundamental debacle, a debacle so fundamental that all others stem from it. -

Milan Kundera, The Unbearable Lightness of Being

The worst sin towards our fellow creatures is not to hate them, but to be indifferent to them. That's the essence of inhumanity. -George Bernard Shaw

Ego's trick is to make us lose sight of our interdependence. That kind of ego-thought gives us a perfect justification to look out only for ourselves. But that is far from the truth. In reality we all depend on each other and we have to help each other. The husband has to help his wife, the wife has to help the husband, the mother has to help her children, and the children are supposed to help the parents too, whether they want to or not.-Gehlek Rinpoche Source: "The Best Buddhist Writing 2005 pg. 165

The hostile attitude of conquering nature ignores the basic interdependence of all things and events---that the world beyond the skin is actually an extension of our own bodies---and will end in destroying the very environment from which we emerge and upon which our whole life depends.