By Shankar Vedantam
A top independent advisory panel today recommended that doctors begin routinely screening all patients for depression, saying that:
America's primary care doctors are missing and mistreating more than half of all cases of the common mental disorder.
Asking all patients who walk into offices for tests, physicals and appointments two simple questions about whether they have experienced some of the warning signs of depression can swiftly begin to identify 90 percent of people who suffer from major depression, according to the U.S. Preventive Services Task Force. The panel is a highly influential group of scientists that sets widely followed standards on topics ranging from prostate cancer screenings to mammograms.
The recommendation is the latest manifestation of the growing recognition that depression is one of the most common -- and most commonly undiagnosed and untreated -- chronic illnesses. About 19 million American adults suffer from depression, and estimates suggest that as many as two-thirds do not get treatment.
The new recommendations could bring many of these people into treatment and add millions to the numbers who are taking antidepressants such as Prozac.
Two-thirds of patients with depression are treated in primary care settings. Primary care doctors also see most patients whose depression goes undiagnosed, as people come through clinics for routine outpatient care.
The task force did not find sufficient evidence to recommend routine depression screening for children and adolescents.
Two questions ought to become part of the basic repertoire of every patient visit, the task force recommended in an announcement that coincided with the American Psychiatric Association's annual meeting here:
If a patient answers yes to either question, the task force recommended that doctors offer patients written or oral questionnaires. These ask more specific questions and establish whether the problems are transient or persistent.
If the problems have lasted throughout the previous two weeks, and have interfered with the patient's ability to perform day-to-day tasks, doctors may make a diagnosis of depression.
"Most patients who are depressed have some diminished function," said Alfred Berg, a professor at the University of Washington in Seattle and the chairman of the task force. "They don't take pleasure in activities, they are not productive, can't concentrate, are often sleep-deprived, don't eat well, have headaches or low back pain. If you go through a formal assessment, you find the depressed patients aren't doing as well."
The task force is widely considered to be more conservative and evidence-based than specialist organizations. Its government funding separates recommendations from personal and financial conflicts of interest. Because its members do not come from any one medical specialty, they tend to have a practical approach, and the task force focuses on issues in which the scientific evidence conclusively shows a large difference.
Washington Post May 21, 2002; Page A01
There are some major problems with these recommendations because they increase the potential of extending the drug based paradigm for this very common disease.
Nicholas Regush, a health reporter/analyst, does a great job analyzing the news and provides a valuable service by alerting us to the problems with the traditional medical paradigm. His column is highly critical of this approach.
However, I have some minor disagreements with Nick that stem from the fact that I have been a physician for over twenty years.
It is my impression that most doctors try to do the best they can with the tools they have.
If you read the current U.S. Preventive Services Task Force (USPSTF) recommendations you will find out that depression is indeed a massive problem in the world.
The World Health Organization identified major depression as the fourth leading cause of worldwide disease in 1990, causing more disability than either heart attacks or strokes.
Depression is indeed a serious problem in our culture.
Unfortunately, the traditional medical paradigm has almost completely capitulated to drug companies by offering drugs as the universal solution. These drugs do not treat the cause of the disease, herein lies the problem.
Rather than criticize the USPTSTF recommendations I applaud their efforts to widen the awareness of this devastating problem.
Rather than relying on the two simple questions the task force recommends, it seems far wiser to use an inventory of symptoms to screen for this major problem. In a book I am currently writing, I have compiled a comprehensive list of symptoms that would provide a more complete evaluation by including behavioral, emotional, physical etc.
With respect to treatment we can virtually eliminate the use of antidepressants with some basic approaches.
As part of following an optimal eating plan and exercise program, it will be very important to optimize omega-3 oils. If you have depression, reading Dr. Stoll's book on this topic could save your life.
Beyond these basics, it is quite clear that energy psychology offers some of the most current and effective tools to address depressiom.
Most know that I am a strong fan of nutritional support, but it is my experience that unresolved emotional trauma causes far more disease than eating French fries and doughnuts.
I have long ago lost count of the people who were eating near perfect diets yet were sick with profound health problems.
So the solution is to:
There are many versions of energy psychology that will work, but my current favorite is EFT. Gary Craig has links on his site that will help you identify clinicians that can provide EFT for you.
Later this year I hope to compile another list that is actually rated by people who have seen these clinicians. It will be part of an overall comprehensive strategy to transform the paradigm.
You might also want to consider my newly revised EFT workshop videos. They will provide you with the basics of how EFT can be used for treating depression. The videos are clearly not a substitute for an experienced professional in the treatment of major depression, (comma added) but hundreds have found them useful to help their depressive episodes.
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