Reluctance to talk about depression

Some people with depression symptoms may not tell their family doctor about it – often out of worry they will be placed on an antidepressant, a new study suggests.

In a survey of more than 1,000 California adults, researchers found that 43% had at least some misgivings about telling their primary care doctor about any depression symptoms.

Their top concern was the possibility that their doctor would prescribe an antidepressant – a worry voiced by 23% of respondents.

Another 16% thought it was not their doctor's job to "deal with emotional issues". And a similar percentage worried that someone – like an employer – might see a diagnosis of depression on their medical records.

Researchers led by Dr Robert A. Bell, of the University of California, Davis, reported the findings in the issue of Annals of Family Medicine.

"This study raises interesting issues that have not really been addressed before," said Dr David Hellerstein, of the New York State Psychiatric Institute and Columbia University Medical Center in New York.

Treating depression

Dr Hellerstein, who was not involved in the study, says past research has generally focused on the doctor's side of things – like whether and how they ask patients about depression symptoms.

Now it would be helpful for studies to look into the reasons that people harbour the attitudes that they do, Dr Hellerstein said.

Regarding the finding on antidepressants, he said, "on one level, it doesn't make sense. If you have depression, why would you worry about getting a treatment that's effective?"

But some people may worry about side effects, or that medication won't help them, Dr Hellerstein noted.

As for effectiveness, about 60% of people who go on antidepressants "feel better" with the first medication they try, according to the US Agency for Healthcare Research and Quality.

In the current study, people seemed to have more misgivings about antidepressant treatment than about "talk therapy". Just under 14% said they might not tell their doctor about any depression symptoms out of concern they would be referred for counselling – versus the 23% who cited antidepressant worries. 

Previous study on depression

Dr Hellerstein said that 20 years ago there might have been more stigma attached to "talking about your feelings". But that may be lessening now.

He also said it was "kind of alarming" that about 16% of study participants thought that mental health was not part of their doctor's job.

The findings are based on telephone interviews with 1,054 California adults who were asked about their beliefs about depression and perceived barriers to getting care for it. They were also screened for current depression symptoms, and asked about any past depression treatment.

Overall, 153 respondents screened positive for moderate to severe depression. And they were more likely than others to have an aversion to antidepressant treatment - 28% vs. 18%. They also tended to see more obstacles overall.

"Ironically," Dr Bell's team writes, "those who most subscribed to potential reasons for not talking to a primary care physician about their depression tended to be those who had the greatest potential to benefit from such conversations."

(Reuters Health, Amy Norton, September 2011)

Read more:

New treatment for depression


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