Depression is one of the most common mental illnesses in the world which brings the effectiveness of depression treatments into question. Depression has been steadily increasing in the world. In 2017, around 17.3 million adults aged 18 or older had experienced at least one major depressive episode in the last year. That accounts for about 6.7% of adults in the US. Dysthymia, which is also a kind of depression, occurs in around 1.5 percent of US adults in a given year.
Let’s understand what depression is and whether depression treatment is as effective as we think it is.
Here is the effectiveness of depression treatments:
- Psychodynamic therapy has a significant effect on depression.
- Some evidence suggests that CBT and medications are equally effective in the treatment of severe depression.
- Antidepressants seem to be effective in moderate, severe, and chronic depression and not much in mild cases.
- A meta-analysis found that IPT performed significantly better than CBT.
- A meta-analysis on the efficacy of peer support interventions (such as peer coaching) for depression found that it was superior to usual care in reducing depressive symptoms.
That is only some of the data on the effectiveness of depression treatments. Continue reading to know more about where to seek effective depression treatment.
What is Depression?
Depression is a kind of mental illness called a mood disorder. It accompanies feelings of sadness, loss, inability to get out of bed in the morning and often affects a person’s daily functioning.
Here are some of the types of depression:
- Major Depression
- Persistent Depressive Disorder
- Bipolar Disorder
- Seasonal Affective Disorder
- Psychotic Depression
- Situational Depression
- Atypical Depression
Depression has been steadily increasing in the world. In 2017, around 17.3 million adults aged 18 or older had experienced at least one major depressive episode in the last year. That accounts for about 6.7% of adults in the US. Dysthymia, which is also a kind of depression, occurs in around 1.5 percent of US adults in a given year.
According to a study, during 2013-2016, 8.1% of Americans aged 20 and over had depression in a given two week period. Another study found that women (10.4%) in the US were almost twice as likely to have depression as men (5.5%). Internationally, the male to female ratio of depression rates, as of 2017, is 2.7% males to 4.1% females.
Moreover, this increase in the number of people suffering from depression is not uniform. Studies show that depression is most common in ages 18 to 25. This demographic is particularly susceptible to mood disorders such as anxiety and depression.
The WHO estimates that more than 300 million people worldwide suffer from depression. It is also the world’s leading cause of disability.
How is Depression Diagnosed in Different Countries?
The diagnosis of depression somewhat varies across several countries. A study on the difference in diagnosis and management of depression conducted in the US, UK, and Germany found that about 90% of physicians listed depression as one of their diagnoses. British and American physicians were more likely to diagnose depression in men. Moreover, American physicians were almost twice as likely to prescribe an antidepressant as British physicians.
That leads to one of the biggest problems with the treatment and management of depression. Any discussion around the effectiveness of depression treatments is incomplete without talking about the rates of antidepressant prescription.
There was a 64% increase in the percentage of people using antidepressants between 1999 and 2014 in the US. According to an analysis from the National Center for Health Statistics, 12.7% of the US population over the age of 12 took antidepressant medication in a given month. Moreover, according to a US representative study, 43.9% of patients had been on an antidepressant for more than five years. In contrast, only 13.4% were on antidepressants as of 1996.
Effectiveness of Antidepressants
Research has started to question the efficacy of antidepressants.
A study found that the efficacy of antidepressants increased with an increase in baseline severity. However, compared to placebo, this difference is too small to be statistically significant. That means that the initial relative increase in their effectiveness may be attributable to decreased responsiveness to placebo.
A meta-analysis found that while the benefits of antidepressants correlated with an increase in depression severity, their effects were minimal or non-existent on average in patients with mild to moderate depression. However, for patients with very severe depression, the benefit of medications over placebo is substantial.
Another study found a substantial publication bias. It showed that while 94% of the published studies had positive outcomes, out of all the studies submitted to the FDA, only 51% were positive. Moreover, a separate meta-analysis of the FDA and journal data found that drug effects were only 32% overall.
While the data for antidepressants is starting to become unfavorable, it is essential to remember that they are not useless. SSRIs and other antidepressants have their place in treatment. Providers may overprescribe them for non-clinical issues. Additionally, they are just not as effective as we thought they were.
Insurance and Mental Health Treatment in the US
An often-overlooked factor that limits depression treatment from being as effective as possible is the accessibility of treatment. Access to proper healthcare is crucial if we want to make a dent in the steadily rising rates of depression.
One of the obstacles that many people face when seeking effective depression treatment is access to insurance. Mental health care can be costly, especially in the US. Sadly, your provider might not take your insurance. Let’s take a look at how prevalent this issue is and how many people have trouble seeking effective depression treatment.
Here are some statistics around mental health care and insurance:
- A study conducted by Pearson et al. collected found that people with mental illness were less likely to have health insurance than those without mental health problems.
- Other researchers have found that mental health care rates for people with severe mental illness are lowest for the uninsured and highest for those with public insurance.
- Moreover, those with mental disorders have substantial out-of-pocket expenditures for medical care, accounting for about 29% of mental health and substance abuse outpatient costs nationally in the US.
- Between 1999-2000 and 2009-2010, people with moderate mental health problems found that the cost barriers to treatment increased, even if they have private coverage, especially if they were uninsured.
Effectiveness of Depression Treatments
Psychodynamic psychotherapy is a particular therapy that explores the client’s needs, urges, and desires. It is different from other forms of therapy in that it is more holistic, long-term, and open-ended.
A meta-analysis by Robinson et al. (1990) summarized the findings of 37 studies that measured outcomes in using psychodynamic psychotherapy for depression treatment. They found that psychodynamic therapy had a significant effect.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is a type of therapy that helps people learn how to identify and change unwanted thought patterns that harm behavior and emotions.
CBT focuses on the content of automatic negative thoughts that contribute to anxiety, depression, and other emotional difficulties. It helps identify, challenge, and change these thoughts with more objective and realistic ones.
A review of meta-analyses that aimed to measure CBT’s efficacy found that CBT for depression was more effective than control conditions (such as being on a waiting list and no treatment).
However, other studies that compared CBT to other active treatments, such as psychodynamic treatment, problem-solving therapy, and interpersonal psychotherapy, found mixed results. Some evidence suggests that CBT and medications are equally effective in the treatment of severe depression.
The most commonly used antidepressants are Tricyclic Antidepressants (TCAs), Selective Serotonin Re-Uptake Inhibitors (SSRIs), and Selective Serotonin Noradrenaline Re-Uptake Inhibitors (SNRIs). These drugs work on the principle that the imbalance of neurotransmitters like serotonin may cause depression. This imbalance might occur when signals cannot pass along the nerves properly. Antidepressants work to increase the availability of these chemicals in different ways.
We’ve already gone over the efficacy of antidepressants in this article. They seem to be effective in moderate, severe, and chronic depression and not as much in mild cases. Moreover, antidepressants often seem to be overprescribed.
Interpersonal psychotherapy(IPT) is a time-limited, focused, and evidence-based approach to treat mood disorders such as anxiety and depression. IPT’s objective is to improve the client’s relationships with others to reduce emotional and cognitive distress. Concerning depression, it can address many of its effects, such as social isolation, unfulfilling relationships, grief, and conflict.
A meta-analysis found that IPT was superior in efficacy to placebo in nine studies. However, the combination of IPT and medication was not better than medication alone. IPT performed significantly better than CBT.
Life Coaching/Mental Health Coaching
A mental health coach excels at helping you get unstuck in life. They work on your thought processes and self-beliefs to create realistic, achievable goals. Additionally, coaches guide you through the process of achieving their goals. They can also help you deal with failure, which is part of moving forward in life.
Coaching is instrumental if the coaches have personal experience overcoming issues that their clients are going through. A meta-analysis on the efficacy of peer support interventions for depression found that peer support interventions were superior to usual care (other forms of psychotherapy and medication) in reducing depressive symptoms. The same meta-analysis found that group CBT and peer interventions were comparable. While this finding is somewhat old, it is quite promising.
Additionally, coaching can be more accessible than standard care for non-clinical issues such as lack of motivation, lack of life purpose, trouble in relationships, etc. It can also be cheaper than other mental health treatments, though it is not a replacement for clinical treatment.
In conclusion, the effectiveness of depression treatments is somewhat questionable. There are some well-established protocols such as CBT and IPT that treat depression effectively. However, there is still room for improvement in terms of the efficacy of the antidepressant medication.
Additionally, new evidence suggests that non-clinical methods such as coaching might be superior to usual care in reducing depressive symptoms. They are also cheaper and more accessible compared to the usual means of care.
If you are stuck in life, have trouble finding meaningful relationships, lack motivation and life purpose, feel isolated, or have any other problems, Healthy Gamer Coaching might be the answer for you. Healthy Gamer Coaching bridges the gap in mental health with affordable, online coaching that drives real results.
After Healthy Gamer Coaching. our clients reported:
- 16% decrease in feelings of depression.
- 15% decrease in feelings of anxiety.
- 14% increase in control.
- 30% increase in life purpose.
Additionally, your depression may not be a mental illness. What do we mean by that? Dr. K explains how you may not have a clinical mental illness in this video: