Depression is a common and serious mental disorder that affects millions of people.
Unfortunately, as many as 50% of depressed individuals remain undiagnosed in primary care settings, where they could benefit from effective treatments such as psychotherapy, antidepressants, and collaborative care programs. This is especially concerning in the aftermath of the COVID-19 pandemic, which has worsened the mental health of many people.
October is National Depression Awareness and Mental Health Screening month. It is crucial to raise awareness of depression because it can have devastating consequences for people with chronic medical conditions. Depression can cause more suffering, worse health outcomes, more pain and physical symptoms, and lower function and quality of life. It can also make healthcare use more chaotic, less effective, and costly.
Let me share with you the story of John, a 70-year-old patient of mine who had type 2 diabetes and depression. He had been living with diabetes for decades, and he had been coping well until a few years ago.
John came to my office after his diabetes educator noticed that he was angry and irritable with the medical staff. She suspected he might have depression. He denied it at first, but I confirmed that he was indeed suffering from a depressive episode despite being on an adequate antidepressant regimen. He had trouble sleeping and thinking clearly. He had lost interest in everything that used to make him happy. He wondered what he had to live for.
His depression was affecting his physical health too. His diabetes was out of control, his kidney disease was getting worse, and symptoms related to his peripheral artery disease were restricting his mobility.
I had first met John 15 years ago, when his endocrinologist referred him to me. He said he could not help John manage his diabetes until his depression was treated. Back then, John had been depressed for three years. His fatigue and brain fog were not just caused by high blood sugar or his kidney disease. He had a serious mental health problem that needed attention. He responded well to antidepressants and psychotherapy and stayed well for over a decade.
But something changed in the past couple of years. John’s physical condition deteriorated, and he became more isolated during the COVID-19 pandemic. He was too proud and independent to ask for help or support from anyone. He withdrew and became more depressed. He stopped doing the things that could make him feel better.
I decided to try a different approach with John. I told him that he was trapped in a negative feedback loop of “feel-bad-do-less”. His physical and social problems were making him feel bad, which made him do less of the things that could make him feel better. He needed to break this loop by doing more of the things that could boost his mood, such as connecting with others, exercising, and engaging in meaningful activities.
We agreed on three action items that he could start right away:
- To visit his family and attend their sports events at least once a week.
- To restart a conditioning program with a physical therapist that he let lapse.
- To resume playing piano after completing treatment he was receiving for a chronic wrist injury.
A few weeks later, John came back to see me. He looked like a new person. He was sitting upright and smiling widely with a sparkle in his eyes. He told me that he had been spending more time with his family, playing honkytonk piano for his grandkids, and was even gardening again. He said that he felt happier and more hopeful than he had in a long time. His diabetes was also better managed, and his kidney function was improving.
John’s story illustrates how vital it is to raise awareness about depression in all facets of healthcare. If not for the astute observation by the diabetes educator who flagged John’s potential need for depression intervention, he might still be wrestling with worsening symptoms or possibly developing an even more severe depressive disorder that would be harder to treat. Systematic depression screening can play an instrumental role in raising awareness in medical settings.
Depression awareness is not only important for healthcare providers, but also for individuals who suffer from depression. Each individual grappling with depression has varying levels of awareness about their symptoms being attributable to depression. In John’s case, it took an honest discussion and motivational interviewing techniques to help him acknowledge what was afflicting him and take action.
We have made significant strides in developing effective treatments for depression and reducing stigma around mental health issues. But these achievements are not enough if we fail to recognize and address depression in the first place. That is why we need to increase awareness of depression and screen for it in primary care settings, so that we can provide timely and appropriate treatment, and improve overall health and wellbeing – to those who need it.
Paul Ciechanowski, MD
Chief Medical Officer
Janus Healthcare Partners
