A new study in the Archives of General Psychiatry examines trends in the treatment of depression between 1998 and 2007, and finds that—surprise, surprise!—we’re treating more depression.
The study finds that the rate of outpatient treatment for depression increased from 2.37 per 100 persons in 1998 to 2.88 per 100 persons in 2007. That is, almost three of every 100 persons reported that they sought some sort of treatment for depression.
Some other findings from the study:
|Percentage of depressed patients on antidepressants||73.8%||75.3%|
|Percentage of depressed patients who received psychotherapy||54%||43%|
|National expenditures for outpatient treatment of depression||$10.05 B||$12.45 B|
|Cost attributed to medications||$4.59 B||$6.60 B|
(1998 numbers adjusted for inflation)
So what does this all mean? Well, for starters, here’s how the study was done: about 23,000 individuals were interviewed about their treatment over the past year. If patients reported seeking help for “depression,” they were included, even though they may have been suffering from dysthymia, a depressed phase of bipolar disorder, an adjustment disorder, or an underlying anxiety or substance use problem. Regarding the expenditures, these numbers were gathered from large databases of office visits and hospitalizations, and data were included only if the providers gave a diagnosis of major depression, dysthymia, or “depression not otherwise specified.”
Note the rise in medication costs, up to $6.6 billion in 2007. (Of this, the proportion borne by Medicare rose from $0.5 to $2.25 billion, most likely due to the implementation of Medicare Part D in 2006.) These numbers reflect a substantial increase in how much money we’re paying for antidepressants and other medications to treat depresssion. (In case you were wondering, the total outlay for the entire Medicare program in 2007 was $375 billion.)
So we’re spending more money on depression treatment, and more than half of that money is on medications for depression. (Incidentally, the same researchers also reported that the percentage of all Americans taking antidepressants in any given year rose from 5% to 10% over the same time period.) Does that mean we’re winning the war on depression? Doesn’t look like it. Does it mean people are more depressed now than they were in the past? Possibly. Is there some other reason why patients are seeking help, and providers just find it more palatable to give a diagnosis of depression? That’s a possibility, too.
All I can say is, when I see numbers rising like this—whether we’re talking about disease rates, costs, or numbers of prescriptions—it means we’re not handling this epidemic very well. The question is, epidemic of what, exactly?
I suggest reading Anatomy of an Epidemic by Robert Whitaker.The increase in depression seems to occur with the rise of advertisements of SSRIs, antidepressants, and mood stabilizers. Their everywhere! Whatever happened to psychoanalysis? I guess that went out the door when HMOs came in. Or perhaps because GP's are now prescibing psychiatric pharmaceuticals.
[…] with 253 million prescriptions written in 2010 alone. Whether this means we are suffering from an epidemic of depression is another thing. In fact, a recent article questions whether we’re suffering from much of […]