Judith Warner wrote this op-ed January 9th, The Wrong Story About Depression, in response to CNN’s and MSNBC’s “startling” news about “sugar pills.”  (Here is a link to The New York Times piece. )   Peter Kramer also reacted immediately to popular press’s coverage, posting this article on Slate’s XX.   Kramer writes “the undertreatment problem is the real news.”

I felt the same way Warner & Kramer did when I read the MSNBC article, which I posted on, but they did a much better job saying and defending the point.  Warner writes:

This is the big picture of mental health care in America: not perfectly healthy people popping pills for no reason, but people with real illnesses lacking access to care; facing barriers like ignorance, stigma and high prices; or finding care that is ineffective.

But here is something new I hadn’t focused on:

That people have come to believe otherwise may be in part because most patients with depression are treated by general practitioners, not psychiatrists. Studies have shown that these primary care doctors don’t strenuously enough screen their patients for depression before prescribing drugs, or closely monitor their care afterward.

In Peter Kramer article on Slate’s XX, Kramer writes “the undertreatment problem is the real news.  As for drugs not working—that’s a complicated story.”  (I quote extensively from the piece.  You may be better served just going straight to his article and reading it.)

Reasoning that it is well-established that antidepressants work for dysthymia—chronic or frequently recurring minor depression—the researchers next eliminated trials in which that sort of mood disorder played a role. The exclusion is important. Of the 1,000 or so studies of depression treated with an FDA-approved drug, the Penn researchers threw out almost 600 for this reason.

When the researchers finished filtering their sample set, Kramer writes that “their analysis [applied] to only six of the original 2,000-plus trials.”

It is this summary of six studies of two medications that has led the press to report more or less conclusively that antidepressants do little for minor mood disorders.

For an answer, we might look to this month’s issue of the Archives of General Psychiatry. A study conducted at Northwestern University appears therein that, had it been published sooner, might well have been included in the Penn research. The trial uses the same outcome measure relied on in the Penn overview. It has no washout period. And it tests Paxil. The core finding is straightforward: While Paxil did moderate depression, the drug’s greater effect was in changing personality.

Kramer draws these conclusions from the Penn study:

They help with acute severe depression. They help with chronic minor depression. And yet they do little for acute, isolated bouts of minor mood disorder. Still, overall, they make patients resilient in a general fashion having to do with personality traits.

Then Kramer says even this conclusion isn’t persuasive, and the study should have been better designed. If you reread the MSNBC article, that’s not what it says. This is why we need more intelligent mental health reporting. Thanks to Warner, Kramer, The New York Times, and Slate’s XX.

Finally at the risk of being repetitive, I quote Kramer again:

To me, the real news of the month comes in another study, from the University of Michigan, in the Archives of General Psychiatry. It found that only one in five Americans with depression has received even one adequate course of treatment in the past year. The criteria for adequate treatment are modest: 60 days of an antidepressant with four doctor or nurse visits over the year or (for talk therapy) four mental health visits lasting 30 minutes or more.

To me, that’s the story that matters. Most depressed people don’t get evaluated; most who are evaluated don’t get treated; and most who are treated are treated poorly.