Why Depression So Often Goes Untreated

Photo: Ranadeep Bania/Unsplash

More than a quarter of America suffers, but millions don’t (or can’t) get help

by Robert Roy Britt

This is the last in a four-part series on preventing depression, a serious and growing mental disorder that can strike at any age and, if untreated, persist and worsen.

Mental health stigmas, antiquated beliefs that psychotherapies are hokum, and social and financial barriers to treatment combine to keep millions of Americans young and old from getting much-needed help with depression, a common and increasingly pervasive mental health disorder that can affect anyone at any age.

“Only about half of all people who need treatment actually get it,” says Tracy Gladstone, PhD, a senior research scientist at the Wellesley Centers for Women.

The pool of need is growing. Teen depression has been rising since at least 2005, and the pandemic has added to adolescent burden. Among American adults, more than a quarter now report symptoms of moderate to severe depression. The statistics presage a potentially dire trajectory. Depression that starts in childhood often persists into adulthood. And even mild depression that first strikes in adulthood can, if untreated, deepen and turn chronic.

But solutions for both preventing and treating depression are right in front of us. We know what works, including self-help strategies anyone can employprofessionally guided talk therapy (otherwise known as psychotherapy), and in some cases (though not all) antidepressants.

Depression itself discourages people from seeking help

Depression is driven by a mix of genetics and experiences. It can range from mild and fleeting to severe and persistent. It can emerge gradually, but in most cases one or more traumatic events trigger the onset. Among the challenges is distinguishing full-blown depression from normal sadness.

Sure, we all feel a little blue now and then, and a few days of moodiness is nothing to worry about, experts say. But when days turn into weeks, when sadness is accompanied by hopelessness or helplessness, a person needs serious strategies and solutions that can simply feel out of reach.

Unlike a broken leg or a nasty infection, depression generates fears and emotions that often keep people from seeking help. Among them are shame, guilt, and the social stigma of depression, including a “fear of being labeled crazy, incompetent, lazy, or feeling ashamed or some other antiquated, biased belief,” says Peter Bolo, MD, medical director of behavioral health at the Atlantic Health System.

If more than a quarter of American adults are feeling symptoms of depression, it’s hard to argue they’re all crazy, lazy, or anything but, well, depressed.

“Unfortunately, there is still a significant amount of stigma associated with accepting a depression diagnosis and seeking mental health support,” says Gladstone, director of Wellesley’s depression-prevention research.

There are other internal barriers to treatment. A depressed person may not recognize their condition for what it is, Bolo says in an email, or they might deny its existence, believing it will go away if ignored. Finally, the disease itself presents challenges to seeking help, from feeling too lethargic, pessimistic, hopeless, or helpless — or even self-destructive, he says.

Lots of people don’t trust psychotherapy or medications

It’s no secret that psychiatric therapy has its enthusiastic cheerleaders and harrumphing detractors. Some people just can’t fathom sharing their innermost thoughts with a stranger, Bolo points out.

“Some folks are fearful of, or skeptical of, psychotherapy, [believing] that it is hogwash or brainwashing or mind-reading, or just silly hocus-pocus and self-indulgent,” Bolo says. “However, there are more, I believe, who are reticent toward medication.”

The reality, research across many decades has established, is that depression is highly treatable. Either psychotherapy or medication can often help, and in many cases a combination of the two is even more effective.

“I think there are still many people who are uncomfortable with traditional psychotherapy models, often because of a general distrust of the mental health care system, or of the healthcare system overall,” Gladstone tells me. “Moreover, not all cultural groups interpret mental health symptoms the same way, and depression knowledge, attitudes, and beliefs may vary for people from different demographic groups.”…



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