Posted May 26, 2004
Undertreatment of Depression
Luisa M. Saffiotti, Ph.D.
Vol. I No. 3 June 1997
Taken from the St. Luke’s Institute web site
"I felt very withdrawn. I felt very much to myself. The sleeping problem was back from the previous week, and there was a lot of anxiety.... I wasn't eating anything. I had a lot of things going together . . . . I'd just like to let everyone know I've been diagnosed with depression."
These words are not fiction, they were spoken last month by Pete Harnish, a pitcher for the New York Mets. F. Rich, N.Y.Times, May 1, 1997.
Depressive disorders, including episodic major depression and dysthymia (chronic low-grade depression) will affect 24% of women and 15% of men at some point in their lifetime. The risk of suffering from depression has increased and the age of onset of depression has decreased. It is a public health problem of increasing significance.
The Journal of the American Medical Association (January 22/29, 1997) reported overwhelming evidence that individuals with depression are seriously underdiagnosed and undertreated. Studies show that between 48% and 67% of individuals suffering for at least 20 years from major depression, dysthymia, or "double depression" (a combination of dysthymia and a major depressive episode) never received an antidepressant medication, although effective treatments for depression have been available for 35 years. Additional studies show that only between 5% and 27% of patients received adequate treatment.
In our years of clinical work we have found that the majority of clergy and religious referred to us were suffering from some form of depression. Issues of lowered mood, decreased energy, loss of zest for life can be seen in a spiritual rather than a mental health context. Sometimes in spiritual direction or in confession, these symptoms may be interpreted as spiritual desolation and not properly recognized as genuine depression.
Other contributing factors which can mask depression in priesthood and religious life:
A diffidence toward mental health professionals and therapeutic interventions.
A tendency to neglect proper self care, physically, mentally, spiritually.
The same impoverished quality of rectory or community life.
A tendency to be out of touch with emotions, and an inability to take one's own 'emotional temperature'.
A lack of adequate communication skills and/or ability to trust.
The significant incidence of undiagnosed trauma (including physical, emotional, and sexual abuse) among both female and male religious.
Particularly notable for their implications for women and men in religious life are the failure of individuals to recognize the symptoms of depression, the tendency to underestimate the severity of depressive symptoms, limited access to treatment resources, and reluctance to seek out mental health treatment for fear of stigma. At SLI we see the JAMA study as an invitation to superiors, formators, and spiritual directors to increase their awareness of and knowledge about depression, to share this information with those entrusted to their care.
Prominent signs and symptoms:
Irritability, withdrawal, crying
Markedly increased or decreased appetite (and related weight gain or loss - weight gain is more typical)
Fatigue, lack of energy or enthusiasm
Neglectfulness in observance of daily obligations, difficulty praying
Low self-esteem, poor self-image, sleep disturbances
Increased alcohol consumption.
Withdrawal, low self-esteem [frequently manifested in failure to take initiative or to speak up]
Burying self in work without actually being very productive, easily becoming overwhelmed by work that was previously manageable
Inability to keep up with regular demands or to organize self adequately
Slacking off or stopping exercise and other leisure activities, loss of energy and vigor
Increased alcohol consumption (often alone)
Sleep disturbances, markedly increased/decreased appetite
In our work at the Institute we find that problematic behavior (e.g. abuse of alcohol or other substances, sexual acting out) often masks underlying depression. If you have questions, feel free to contact the evaluation program, the residential treatment program, or the women's program at SLI.
Luisa M. Saffiotti, Ph.D., a Clinical Psychologist, formerly worked at Saint Luke Institute and is now in private practice.