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Myriad masks hide depression of epidemic proportions

The symptoms can run the gamut from headaches and chest pains to memory loss and extreme apathy. The diagnoses can range from heart disease to Alzheimer's. But the real cause is often depression, a disorder of epidemic proportions that is typically unrecognized, misdiagnosed or improperly treated.

According to various surveys and studies, fewer than half of Americans consider depression a health problem, and more than two in five say it is a sign of personal weakness.

People who complain of depression are commonly admonished to snap out of it. Countless others with physical symptoms like recurring headaches or backaches never realize that their complaints emanate from depression.

As a result, many depressed people never bring their problems to medical attention. And when they do, they typically see doctors who are not specialists in mental health, who are likely to miss the diagnosis of severe depression at least half the time, according to a 1989 study by Rand Corp., a research institution in Santa Monica, Calif. The rate of misdiagnosis is even higher for the more common milder forms of depression.

Even when the diagnosis is correct and medication prescribed, it is frequently the wrong drug or too low a dose. Such mistaken treatment, in turn, feeds into the popular notion that not much can be done about depression, when in fact at least 80 percent of patients can obtain significant relief through modern anti-depressants and relatively brief psychotherapy.

Mental health professionals are striving to reverse the pessimistic view of depression, alert people to its many signs and properly recognize and treat patients with this life-impairing disorder.

On Thursday, National Depression Screening Day, psychiatrists and other mental health professionals in all 50 states will volunteer their time in an effort to uncover some of the millions of cases of undiagnosed depression.

The program was developed by Dr. Douglas Jacobs, a Harvard University psychiatrist, in cooperation with the American Psychiatric Association, Harvard's Department of Psychiatry and the National Depressive and Manic-Depressive Association.

Free screenings for signs of clinical depression will be offered to an estimated 30,000 people at more than 300 hospitals, mental health centers and college health services. A toll-free number, (800) 562-8686, has been set up to help people find out where and when to go for a confidential screening.

Last year's screening day saved the lives of at least three people with strong suicidal feelings who required immediate hospitalization. In addition, more than half of the people screened, who, of course, were self-selected, were found to score positive for depression.

Although most depressed people get better on their own within six to 24 months without treatment, early diagnosis and treatment can dramatically reduce the length and intensity of depression.

Treatment may also help to reduce the chances that the depression will recur. If the depression is severe or if the symptoms interfere seriously with a person's life, anti-depressant medication is commonly prescribed. These drugs are not addictive and do not adversely affect behavior.

Instead of medication or in addition to it, psychotherapy may be offered. One popular approach is short-term counseling that focuses on the patients' distorted thinking and negative views of themselves and the world. Another brief approach focuses on the patients' conflicted relationships with others.

Longer-term analytical therapy that seeks insights into a person's childhood rarely achieves better results in alleviating depression, although this approach may be desirable for other reasons.

Each year, according to the National Institute of Mental Health, depression strikes 15-million Americans. At any one time, according to experts at the University of Michigan Medical Center, 6 to 10 percent of the population is clinically depressed, with women twice as likely as men to be suffering from this debilitating problem.

The cost to society is staggering, but it is usually poorly measured and underappreciated. In 1986 the economic burden of depression was estimated by psychiatric and public health experts at Duke University to be $16.3-billion a year for major depression alone.

Lesser degrees of depression are far more common and, as a result, even more costly. People who suffer from depression miss more days of work than those with heart disease. While they are at work, their productivity commonly suffers, and at home their family and other personal relationships often become severely strained.

Depressed people are also more likely to seek medical care, frequently ending up on a medical merry-go-round, moving from one doctor to another in search of a cause for physical symptoms that are commonly the guise of depression.

In its most classic forms, depression results in feelings of sadness, loneliness, apathy, worthlessness, guilt, pessimism or hopelessness. Normal drives are severely diminished, resulting in a loss of appetite and sex drive, sleep disturbances and emotional withdrawal. Memory may be impaired and mental functions and body movements may be slowed.

But instead of telling doctors that they feel sad or hopeless, at least half of depressed patients complain of a physical problem: headache, constipation, chronic fatigue, weight loss, insomnia, backache or indigestion, prompting a battery of tests that reveal nothing about the real cause and may result in mistreatment.

Some patients, unaware that they are depressed, instead admit to feeling extremely irritable, angry or hostile. Or they may complain of an overwhelming listlessness, apathy and a loss of interest in things they once enjoyed.

The physicians at Duke University Medical Center believe a revision is needed in the diagnostic criteria used in determining whether a person is depressed. Too many patients with significant though lesser degrees of depression are now missed, they found through personal interviews in five counties of North Carolina.

Yet those with such minor depression, which is also highly treatable, are at increased risk of having an anxiety disorder or suffering a major depression within one year, their follow-up survey showed.