A new study published August 29, 2016, in JAMA Internal Medicine showed that of 46,417 adults, 8.4 percent of them screened positive for depression. Yet of those 3,899 people, only 28.7 percent received any treatment.1
That means the rest — all 42,318 of them – were not being helped. Many may have chosen to medicate their depression themselves with drugs and alcohol, often developing a co-occurring addiction in the process.
Co-occurring substance use and mental health disorders should be treated together in integrated health care environments with qualified psychiatrists and addiction specialists. Unfortunately, this is not happening as much as it should be.
Most People Given Antidepressants Aren’t Even Depressed
According to the study, among all adults treated for depression, only 30 percent had a positive depression screen. That means the rest of them likely were being treated for depression-like systems when the root problem could be a substance abuse disorder or some other health condition. Most commonly, doctors treated these patients by prescribing antidepressants.
“Over the past several years…there has been a substantial increase in antidepressant prescriptions, which have become the most commonly prescribed class of medications in the United States,” wrote the authors, led by Dr. Mark Olfson of the College of Physicians and Surgeons of Columbia University, New York.
Olfson and colleagues arrived at their findings after analyzing data from the 2012 and 2013 Medical Expenditure Panel Surveys (MEPS). “MEPS is the most complete source of data on the cost and use of healthcare and health insurance coverage,” according to its website.2
Depression diagnoses were made via answers patients gave to questionnaires. A limitation of the study is the inherent bias that can come from self-reporting.
People with depression who try to make themselves feel better, or self-medicate, could do so by turning to alcohol, stimulants (such as methamphetamine or cocaine), opiates or marijuana. Each of these indulgences can lead to addiction and come with its own set of new dangers. Not only does the depression remain untreated, but new problems arise.
Alcohol, Marijuana, Painkillers – They Won’t Help Your Depression
For people with depression who are taking antidepressants and washing them down with alcohol, the drinks counteract the therapeutic effect of the antidepressant. Although someone may feel better for a little while after having a drink, the long-term effects of alcohol are not uplifting for someone with depression. In fact, research has shown that the presence of one disorder (depression or alcohol use) doubles the risk for the other.3
Marijuana works in much the same way. A little bit of cannabis has been shown not to be harmful to the quality of life among people who use it for their depression, but too much can make symptoms worse, particularly among women.4
Opiates are intended for physical pain, not depression. They have proven to be so addictive that they have created a national crisis. Even for people experiencing intense physical pain, most doctors only prescribe opiates as a last resort.
Integrated Mental Health Services Mean Better Outcomes
Unfortunately, even a mental illness as common as depression is stigmatized in our society — so much so that many people are ashamed to ask for help. If depression can be diagnosed early, it’s much easier to treat. If it lingers, it becomes a much more complicated problem, particularly if co-occurring substance abuse problems also are allowed to fester.
The study found that among people treated for depression, 73.3 percent were seeking help from general medical professionals – no doubt in part because of the stigma associated with seeing a psychiatrist and/or addiction specialist. This is despite the fact that “prior research has shown that, compared with depressed primary care patients who received standard care, those who receive integrated mental health services tend to achieve more favorable depression outcomes,” the authors reported.
Antidepressants Alone Aren’t the Quick Fix
Sometimes depression can be treated without medications. Physical activity, such as yoga and other forms of exercise, have proven to be helpful for some patients. Other people benefit from talk or Cognitive Behavioral Therapy, usually in conjunction with medication.
Studies have shown that for people with mild depression, antidepressants are not any more helpful than a placebo (sugar pill), the authors reported.
“Among adults who receive depression care, it is important to align patients with appropriate treatments and healthcare professionals,” the study concludes. “With dissemination of integrated care models, opportunities exist to promote depression care that is neither too intensive nor insufficient for each patient’s clinical needs.”
2.U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey (MEPS). Retrieved Sept. 3, 2016, from https://meps.ahrq.gov/mepsweb/
3.Boden, J. et al. (2011, March 7). Alcohol and Depression. Addiction. Retrieved Sept. 3, 2016, from https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03351.x/full
4.Aspis, I. et al. (2015, Sept. 10). Cannabis use and quality of life among individuals with depressive disorders. Psychiatry Research. Retrieved Sept. 3, 2016, from https://www.ncbi.nlm.nih.gov/pubmed/26388103
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.