The Depressing Truth for Rural America

Rural Americans are still dangerously undiagnosed and undertreated for depression according to experts at the annual conference sponsored by the National Rural Health Association (NRHA). "The national prevalence and consequences of depression have been documented for years, what is most shocking is that even among those who get help, only 10 to 25 percent are adequately treated. We need to educate physicians, especially rural area physicians of the tremendous opportunity to control these statistics and to make a real, positive difference in people's lives," said Baltazar Gomez-Mancilla, M.D., Ph.D., Clinical Program Leader for Central Nervous System Clinical Development at Pharmacia Corporation. "

The National Depressive and Manic-Depressive Association (NDMDA) conducted an online survey, asking patients with depression to rate their satisfaction with their treatment; Of 1,370 patients surveyed, fewer than one-third said that they were very satisfied with their treatment. Despite treatment, most respondents said that depression moderately or extremely impaired their social life (81 percent), family life (79 percent) and work performance (72 percent) in the last month. Some of the reasons cited for dissatisfaction included patients' intolerance of side effects, the lack of efficacy or patients' perceptions that they felt better and didn't need medication any longer.

According to Dr. Gomez-Mancilla, the new goals of treatment are remission and recovery, not just response to the medication. A recent editorial in The New England Journal of Medicine summarized research that confirms the superiority of combination medical-talk therapy in the treatment of depression and according to the National Alliance for the Mentally Ill, depression has a 70 to 80 percent treatment success rate. Many Americans, however, still go untreated or are under-treated because physicians and patients aren't aware of the warning signs of depression or of advances in pharmacological treatment Recent research is looking at a norepinephrine-specific antidepressant, reboxetine. While similar to the more commonly cited neurotransmitter, serotonin, depletion of norepinephrine in the brain seems more closely related to issues of motivation, interest and energy (while serotonin affects mood and irritability Drugs such as this may improve patient satisfaction and social functioning.

"It's imperative that we, as rural healthcare providers, recognize the symptoms of depression in our patients who are suffering and don't even know it," said Katherine Nordal, Ph.D., a Mississippi psychologist. "I've been in practice for 20 years and I see a patient with depression most days of the week. Most of them don't realize that they have an illness that can be effectively treated with the right combination of pharmacological and psychological therapy."

It should be noted that untreated depression carries a 15 percent suicide rate. Awareness of new developments in identifying and managing depression and a willingness to use them may help to reduce the impact of this disease in rural America.

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