Battling the Blues
Increasing number of resources are accessible to help individuals battle depression
Landro, L. - Wall Street Journal - 12/19/2011
'Tis the season to be cheerful—or not a whole lot, if you are afflicted by depression.
According to the Centers for Disease Control and Prevention, nearly 8% of individuals 50 and older report current depression, and close to 16% report a diagnosis of depression sometime in the course of their lives. The holiday seasons, with their focus on good cheer, can exacerbate the blues.
The good news is that there are more assets than ever for screening and therapy to avoid wasting years feeling bad. A growing number of primary-care providers are using standardized questionnaires to screen for depressive disorder and other mental-health ailments during routine visits. Providers also are coordinating care of depressed patients with behavioral-health specialists in so-called mental-health integration programs.
The U. S. Preventive Services Task Force, whose recommendations are utilized to determine what Medicare and private insurers include, recommended in 2009 that adults be tested for depression in primary-care businesses—as long as there are devices in place to guarantee appropriate diagnosis, successful treatment and follow-up care. In October, Medicare said it will start covering annual depression screening if those requirements are fulfilled, though patients will still have to shoulder some co-payments and deductibles for treatment. And new federal regulations prohibit providers from establishing stricter limitations on mental-health benefits than they do for other conditions.
Doctors are aligning with community mental-health services to help provide follow-up care, and several programs are teaching nurses and social workers to offer various kinds of counseling that are less expensive and strenuous than sessions with a psychiatrist or psychologist. One fast-growing program, known as Impact—for Improving Mood-Promoting Access to Collaborative Treatment—was shown in a large trial a decade ago to decrease depressive disorders substantially, and is backed by the CDC.
Usually patients are first screened with a set of questions regarded as the PHQ-9, which asks such questions as how frequently in the past two weeks they have felt very little interest or pleasure in doing things, had trouble focusing, or felt down, depressed or hopeless. Physicians prescribe antidepressants where appropriate, but the Impact program also depends on a depression-care supervisor. The manager—generally a nurse or social worker—offers educational materials on depression, encourages patients to participate in some form of "behavioral activation" (such as engaging in physical exercise or scheduling pleasant events) and, if necessary, provides 6 to 8 sessions of "problem-solving therapy" aimed at helping patients learn skills to grapple with their challenges.
To monitor results, the PHQ-9 screening process is replicated with every patient visit. "It's like dealing with high blood pressure: If a patient isn't getting better, we have to make a change in treatment, " says Jurgen Unutzer, director of the University of Washington's Advancing Integrated Mental Health Solutions center, which trains medical practitioners to use the Impact model.
Coping with Stress
A comparable approach calls for cognitive behavioral counseling, which helps patients cope with their moods and change negative means of thinking to cope better with demanding situations, says Dolores Gallagher-Thompson, director of the Older Adult and Family Center at Stanford University's University of Medicine. The Stanford program conducts training courses for health care professionals on the essentials of cognitive behavioral treatment for elderly adults.
Dr. Gallagher-Thompson notes that major depression frequently occurs with changed lifestyle conditions. People nearing retirement in a tough economic climate may have lost jobs and have difficulties obtaining new employment, or may confront later-life divorces. And when their own means are abruptly restricted, they can no longer travel, dine out, buy holiday gifts or treat themselves to other things that could make them feel better. In these conditions, "even a brief course of cognitive behavioral treatment with four to 6 sessions can be extremely effective, " Dr. Gallagher-Thompson affirms.
Yet another program endorsed by the CDC, Healthy Ideas—for Identifying Depression, Empowering Activities for Seniors—concentrates on connecting depressed elderly adults who have persistent health problems with community mental-wellness programs and products, such as community agencies on aging. Nancy Wilson, director of the program and an assistant professor at the Baylor College of Medicine in Houston, says a number of elderly adults are hesitant to seek out treatment because they come from a generation that often still associates depression with stigma. But for those in middle age, "there is a lot more realization and awareness that depression is a standard component of the life experience and is a treatable condition" Ms. Wilson says.