Underuse of Antidepressants in Major Depression

Abstract

Epidemiologic studies have reported disturbingly low rates of treatment for major depression in the United States. To better understand this phenomenon, we studied the prevalence and predictors of antidepressant treatment in a national sample of individuals with major depression. Between 1988 and 1994, 7589 individuals, aged 17-39 years and drawn from a national probability sample, were administered the Diagnostic Interview Schedule as part of the National Health and Nutrition Examination Survey. Interviewers asked about prescription drug use and checked medication bottles to record the name and type of medications. A total of 312 individuals, or 4.1% of the sample, met DSM-III criteria for current major depression. Only 7.4% of those with current major depression were being treated with an antidepressant. Among individuals with current major depression, being insured and having a primary care provider each predicted a 4-fold increase in odds of antidepressant treatment; telling the primary provider about depressive symptoms predicted a 10-fold increase in treatment. The study's findings support the notion that a serious gap exists between the established efficacy of antidepressant medications and rates of treatment for major depression in the "real world." Underreporting of depressive symptoms to providers and problems with access to general medical care appear to be 2 major contributors to this problem.