The U.S. Prevention Services Task Force just announced that all adults should be routinely screened for depression.
What is the USPSTF, and what’s the big deal?
I read Listening to Prozac in the early 90s, which predicted a future, with some trepidation, of healthy people fine-tuning their personalities with medications for social or corporate advantage. Shy and reserved people could choose to be Captains of Industry. The meek could inherit the earth. It sounded like a bad science fiction movie.
The notion of medication for social or work advantage was made possible because this new antidepressant (Prozac) was “clean”— it had few, if any, serious side effects. Psychiatric medicines before Prozac were very blunt instruments. They had many side effects that could be worse than the condition they were prescribed to treat.
Antipsychotics helped with hallucinations, but could sedate you into a semi-comatose state. Antidepressants made you sleepy, and your mouth felt too dry to speak without a glass of water. Tranquilizers did more to put you to sleep than to treat your anxiety.
None of these medications were good candidates for medication-induced social advantage, but Prozac was. It was going to change the world. The 90s were a heady time.
Once the first SSRI (Prozac) was discovered, a frenzy of drug development followed with dozens of SSRI variations, all patented, tested and sold. While these drugs failed to turn the average introvert into presidential candidate material, they have helped millions cope with depression.
Depression is an insidious and terrible disease. Because we live in our heads, what we think always feels “normal” to us. Depression doesn’t feel like a disease to the person with it. Depression just feels like a real bad day/week/month and an appropriate response to the bad stuff going on in all of our lives. But things pile up, and for someone with depression, soon life starts being overwhelming. Even the easy stuff is too hard to do.
Hopefully, people feeling like this will look for some help, but of course not everybody does. Untreated depression is a huge burden on individuals and their families. There is a high risk of self-harm, which can utterly surprise the family around them.
Lately, there has been an “evidence-based medicine” movement in the medical community. This is a result of looking into diagnostics and treatments with the power of large numbers of patients and computers. This will show which treatments work, which don’t, and how well they work. There have been some surprises along the way. Sacred cows have been banished.
Depression and its diagnosis/treatment have undergone this rigorous analysis. Findings show that a large number of people do not seek medical care for depression, and that depression is a serious disease with significant morbidity and mortality. Findings also show that treatment for depression decreases the burden of the disease, reducing morbidity and mortality.
Strong evidence backs the treatment of depression, and the treatment works for most patients. People can be effectively screened for depression using one of several brief questionnaires. If positive, the provider can further evaluate and treat, if warranted.
For years, the stigma of depression was almost as bad as the disease. With detailed studies of brain chemistry, we have found the mood is closely controlled by dopamine levels. If you do not have enough, you will experience depression. It is simply a chemical that needs to be raised a bit to make you more even with most folks. Low dopamine is no more embarrassing than high blood pressure. You take a pill, fix it and go about your life, with perhaps a little more spring in your step.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.
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