On current estimates around a quarter of people with clinical depression remain undiagnosed. They may go through life feeling unhappy, introspective and moody. Their symptoms may have been with them for so long that they can't recall what it means to be without them and they may have no particular recollection of the slide towards depression or what they were like before.
Very often, it is family or friends that really notice the difference, and they need to feel more confident and perhaps be more persistent in getting the person to seek help. Moreover, physicians can do a lot more to help. These are just some of the conclusions from a recent study published in the Journal of General Internal Medicine by lead author Professor Ronald M. Epstein, M.D.
For some people finding the words to explain how they feel can be very difficult. Although we know quite a lot about depression, many people who suffer with it still don't seem to recognize they have it. Neither, it appears in some cases, might their doctor. According to Epstein, people can often identify that something is wrong, but their common-sense understanding of depression doesn't seem to match with how they feel. Currently, the author states, many doctors maintain a one-dimensional view of depression and need to adjust their view to a patient's experience.
There is a somewhat stereotypical view of depression into which many people don't fit. They don't necessarily drag out their words, heave themselves around, or sit slumped in a chair. They may continue with their daily routines and have quite challenging jobs. In other words the behavior often associated with depression is not always consistent. It may also be being masked by the person who feels terrible, but has no plans to portray this to the outside world.
If your family doctor suspects depression they may do one of a few things. They may ask directly, ‘do you think you are depressed?' or they may ask a few questions from a symptoms checklist. If the patient's views do not correspond with such measures there is a chance they may slip through the net in terms of a proper diagnosis and subsequent treatment. For this reason the study recommends that exclusive use of symptoms checklists should be avoided and that the patient should not be expected to endorse a self-diagnosis of depression.
In certain situations the patient needs the physician to explain how personality, genetic and social factors can work together and result in depression. They need to explain that people can experience depression in many different ways and, importantly, that it can be treated.
The study stipulates that ‘naming' a condition or disease is an important pre-condition for subsequent changes in behavior. The implication here is that not naming simply delays treatment and allows the problem to worsen. The fact that people can have their distressed identified as something specific, and that a variety of treatment options both clinical and psychological are open to them, gives meaning to their situation and provides options as to a way forward.
Ronald M. Epstein, Paul R. Duberstein, Mitchell D. Feldman, Aaron B. Rochlen, Robert A. Bell, Richard L. Kravitz, Camille Cipri, Jennifer D. Becker, Patricia M. Bamonti, Debora A. Paterniti. 'I Didn't Know What Was Wrong:' How People With Undiagnosed Depression Recognize, Name and Explain Their Distress. Journal of General Internal Medicine, 2010; DOI:
University of Rochester Medical Center (2010, May 20). 'I didn't know what was wrong': Physicians should help patients with depression name their problem, experts urge. ScienceDaily. Retrieved June 7, 2010, from http://www.sciencedaily.com /releases/2010/05/100520112353.htm