TUESDAY, Sept. 13 (HealthDay News) -- For a nation that seems
ready to pop a pill for any ill, a new study suggests that the
opposite seems true for some people with symptoms of depression,
whose concerns about the side effects of antidepressants were the
top reason they wouldn't disclose warning signs to their
A phone survey of more than 1,000 adults who had previously
participated in the California Behavioral Risk Factor Survey
System, which probed depression-related beliefs, showed that 43
percent reported one or more reasons for not talking to their
primary care physician about their depression. Nearly a quarter of
them worried that their doctor would recommend antidepressants --
the most frequently cited reason for withholding the
Other stated barriers to sharing depressive symptoms included
the belief that it's not a primary care physician's job to deal
with emotional issues (16 percent) and concerns about medical
record confidentiality (15 percent). At least 10 percent said they
were fearful of being referred to a counselor or psychiatrist and
of being labeled a psychiatric patient.
"When patients are diagnosed with depression, they can go into a state of shock emotionally and view it as some kind of indictment of personality or character," said Dr. Norman Sussman, a professor of psychiatry at New York University Langone Medical Center, who was not involved in the study. "People would almost prefer to get a serious medical diagnosis than be told they have a psychiatric disorder."
The study is published in the September/October 2011 issue of
Annals of Family Medicine, and was supported by a grant from the National Institute of Mental Health.
About 10 percent of Americans suffer from depression at any
given time, according to the U.S. Centers for Disease Control and
Prevention, which released a report early this month indicating
about half the population will experience some form of mental
health problem at some point in their lives.
Study authors noted the irony that those who were most reluctant
to talk to a primary care physician about their depression tended
to be those who had the most potential to benefit from such a
conversation -- patients with moderate to severe depressive
Co-author Dr. Richard L. Kravitz, a professor of internal
medicine at University of California, Davis, said targeted
education programs -- such as brochures or posters in primary care
offices reminding patients that doctors are interested in hearing
about symptoms of depression -- are simple ways to nudge
conversations that could be life-altering or even lifesaving.
"On the one hand, the fact that 16 percent of patients felt it wasn't their primary doctor's job to deal with depression meant that [84 percent] did feel it was within their doctor's purview," said Kravitz, also co-vice chair of research in the department of internal medicine. "Always, the glass is half full or half empty. But overall, the news is mixed and there are . . . some simple things physicians can do in their own practices."
Also a concern is that primary care physicians may fail to
recognize depressive symptoms in their patients, said Dr. Alan
Manevitz, a clinical psychiatrist at Lenox Hill Hospital in New
York. Manevitz, noting that many primary doctors prescribe
anti-depressants after a "haphazard" diagnostic process, may not
follow up correctly because of time constraints or an
overconcentration on physical complaints.
"A major reason people don't like to reveal things about themselves is they're afraid their doctor then may not take physical symptoms seriously -- they're worried their symptoms may be minimized because they're depressed," he said. "That's a myth. I think it's something doctors are much more sophisticated about."
Sussman said the implications of not reporting and treating
depression can be serious, with damaging effects on careers,
relationships and overall health. About 8.4 million Americans had
suicidal thoughts in 2008 and 2.2 million made plans to kill
themselves, according to the recent CDC report.
"The patients are correct in that there's a certain amount of misgivings in being treated with antidepressants," which are linked to sexual dysfunction, weight gain and even some cardiac effects, Sussman said. "No one wants to take these medications if they don't have to, but at least two-thirds get some benefit. So there are consequences of not telling your doctor."
In some cases, physicians can work with patients' concerns about
medication side effects by starting with the lowest doses of
antidepressants known to be effective. Patients who choose a
treatment plan that does not include antidepressants can also
benefit from a referral to a psychologist, who can work with them
in talk therapy and closely monitor their depression.
For more about depression, visit the
U.S. Centers for Disease Control and Depression.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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