Physicians Speak Out on Depression
Depression is a painful and often debilitating disease that affects nearly everyone directly or indirectly.
In a recent study by Epocrates, over 500 clinicians shared their opinions on trends in diagnosis, gender differences, risk factors and personal experience with depression.
We encourage you to view the survey results, listen to a Q&A with a UCLA psychiatrist, and share your opinions below.
View the survey results »
In approximately what percent of your patients have you noticed symptoms of depression?
How prevalent are symptoms of depression?
- Nearly 40% of clinicians noticed depression symptoms in at least 40% of their patients
- Over 90% of clinicians noticed symptoms in at least 20% of their patients
- Depression affects almost 10% of the population, or 19 million Americans, in a given year (According to the National Institutes of Health)
For your patients that show symptoms of depression, please estimate the percent with whom you have discussed treatment options.
Are clinicians discussing treatment options with depressed patients?
- 75% of clinicians have discussed treatment with at least 40% of their patients
How likely are you to discuss depression with men compared to women?
Does gender play a role in discussing depression?
- 30% of clinicians report being less likely to discuss depression with men
- Clinicians say it is more difficult to treat men because they are less “open” than women, and more resistant to addressing depression
- The rate of suicide in men is four times that of women (National Institute of Mental Health)
To what extent do you agree or disagree that physicians are hesitant to diagnose depression?
Are physicians hesitant to diagnose depression?
- More than half of respondents believe physicians are hesitant to diagnose patients with depression
Why do you believe physicians are hesitant to diagnose depression?
| Resistance from patients | Uncertainty of diagnosis | Physical ailments are higher priority | Social stigma concerns | Inability to follow-up on treatment | Do not view depression as a disease | Time-consuming diagnosis |
|---|---|---|---|---|---|---|
|
Scale in percentage of respondents: 0% 20% 40% 60% 80% 100% |
||||||
| 63% | 51% | 51% | 51% | 31% | 17% | 10% |
Why does depression go undiagnosed?
- Resistance from patients is reported as the leading reason for not diagnosing depression
- More than half of clinicians also reported uncertainty about the diagnosis and concerns about social acceptance
- 17% of respondents believe physicians do not recognize depression as a disease
Note: Respondents may select all that apply
How has the percentage of your patients diagnosed with depression changed in the last five years?
Are Americans more depressed?
- 85% have seen an increase in patients with depression over the past 5 years
Note: No clinicians reported a decrease
Why do you believe there has been an increase in depression among Americans?
| More disease awareness | More patients seeking help | Increase in stressful life events | Increase in work-related stresses | Increase in societal pressures | Increase in social isolation | Impact of current events | Increase in single parent families | Increase in obesity rate |
|---|---|---|---|---|---|---|---|---|
|
Scale in percentage of respondents: 0% 20% 40% 60% 80% 100% |
||||||||
| 52% | 42% | 32% | 28% | 25% | 24% | 15% | 10% | 10% |
Why is there an increase in depression among Americans?
- Greater disease awareness may be leading more patients to seek help
- Greater stress and societal expectations are seen as contributing to depression
Note: Respondents may select up to 3; includes responses >10%
What do you believe are the leading risk factors for depression?
| Stress | Family history | Medical illness | Social status | Gender | Income level | Age |
|---|---|---|---|---|---|---|
|
Scale in percentage of respondents: 0% 20% 40% 60% 80% 100% |
||||||
| 80% | 78% | 57% | 21% | 17% | 14% | 12% |
What are risk factors for depression?
- Clinicians rate stress and family history as the leading risk factors for depression
- Nearly 60% of respondents identified other medical illness as a key risk factor for depression
Note: Respondents may select up to 3; includes responses >10%
Have you personally ever experienced depression?
Do clinicians experience depression?
- More than half of clinicians have experienced depression in their lifetime
- Clinicians may experience a higher incidence of depression than the general public, of whom it is estimated that up to 25% of will likely become clinically depressed in their lifetime
- 12% of respondents reported missing work because they felt depressed
What factors do you believe contributed the most to your depression?
| Job-related stress | Major life event | Grief over loss of loved one | Interpersonal disputes | Family history | Social isolation | Serious illness | Abuse |
|---|---|---|---|---|---|---|---|
|
Scale in percentage of respondents: 0% 20% 40% 60% 80% 100% |
|||||||
| 62% | 62% | 36% | 29% | 29% | 20% | 15% | 10% |
What are key contributors to clinicians’ depression?
- Overall, clinicians believe professional stress and personal events are the leading contributors to their depression
- Only 29% of clinicians view family history as a contributor for their depression; however, 78% believe it’s a key factor for their patients
Note: Respondents may select all that apply; includes responses >10%
Do you believe that patients with depression can be cured?
Is depression curable?
- 70% of clinicians believe depression can be cured
What do you recommend for your patients experiencing depression?
| Pharmacotherapy | Psychotherapy | Health-related lifestyle change | Social support | Refer patient to psychiatrist | ||
|---|---|---|---|---|---|---|
|
Scale in percentage of respondents: 0% 20% 40% 60% 80% 100% |
||||||
| 96% | 61% | 60% | 43% | 21% | ||
What do clinicians recommend for depression?
- While nearly all clinicians primarily recommend therapeutic treatment for patients, the majority also recommend social and lifestyle changes
- 80% of depressed people are not currently receiving any treatment (National Institutes of Health)
Note: Includes responses >10%
What type of impact do you feel the shootings at Virginia Tech had on the public’s perception of depression?
| Increased awareness of the disease | Increased recognition of depression as a mental illness | Created fear of people with depression | Increased friend/ family intervention for depression | Caused depression among those affected | More people sought treatment | More sympathy for depressed people | No impact |
|---|---|---|---|---|---|---|---|
|
Scale in percentage of respondents: 0% 20% 40% 60% 80% 100% |
|||||||
| 58% | 51% | 38% | 34% | 28% | 10% | 8% | 4% |
How did the Virginia Tech shootings impact views on depression?
- More than half of clinicians believe the events increased awareness of the disease and/or the disease is more recognized as a mental illness
- Nearly 40% believe it has created fear of people with depression
Note: Respondents may select up to 3
Notes: Depression Survey Background
Survey includes 500 Epocrates clinicians comprising physicians, nurse practitioners and physician assistants.
- 500 Epocrates clinicians:
- 300 physicians
- 100 nurse practitioners
- 100 physician assistants
Thank you for viewing the results of our depression survey.
We invite you to share your thoughts on the topic and view the opinions of your colleagues in the discussion below. We look forward to sharing new insights from Epocrates users with you in the future.
Featured Podcast: Q&A Diagnosing Depression (9:52)
Download to iTunes or Listen now:
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Although it’s not the cure for everything in the mental health field - I’ve seen micro-current (CME & MET) work with amazing results. I think that it’s probably rejected by most simply because it’s associated with the old electric shock therapy. I know that the military/VA is also using it based on studies that are 9-10 yrs old. Anything that helps in this field should be explored and tried (if appropriate) to help people return to a more “normalized” lifestyle.
This comment is offensive!reading those comments, really gives you an insight of people suffering with this debilitating illness or disorder. I am a 2nd year mental health student nurse, and I struggle with understanding the terms ‘disorder’ and ‘illness’ used intermittendly in psychiatry. However, there is no right or wrong. In my profession, what is important is showing empathy and understanding the whole person as each is different and will have varied experiences of depression. I am impressed with this website as it may bring people hope to know others have similar experiences.
This comment is offensive!M..
Untill recently, I thought depression was something a person could control. I spent more then 22 years in my employment, promoting 3 times in the last 6 years, only to have a particular supervisor massively retaliate against me for reporting unlawful activities. Within a short time, I developed severe major depression (single episode). The stigma which goes with this is horrifying and humiliating. I have lost all personal and professional credibility along with self respect and confidence. I had no idea of the massive impact this would have on me emotionally and physically. I have now been “totally disabled” for the past 9 months, with very little improvement. I have learned that this is not something I or anyone else can control as God knows I have tried. The effect will be forever for my family and myself. If you cannot understand this illness without experiencing it. Those who think it is a choice are those who cause the negative, inaccurate public opinion. If you care about ill people, then be come a part of the solution instead the the trier of fact without knowledge, Rick Stotelmeyer. You work in the field…you should know better…knowledge is power.
This comment is offensive!As a therpaist with twenty-seven years’ experience, inpatient and private practice and thirteen of those finally diagnosed with melancholic clinical depression (the kind where anxiety is a major feature), I’m intrigued by the many reactions I read here. I firmly believe that a screening by an experienced counselor or PCP who addresses the reality of possible biological contributing factors as well as the situational stressors is paramount. The need for medicine isn’t always present or even long-term.-For me, learned the hard way, it is, but do I thank God for it! Didn’t fix the longstanding issues, but a supportively confrontational therapist and God brought tremendous growth and healing.
And Ruthy, sounds like you know what you need to do - or stop doing. I pray you don’t crash first. I’m a recovered workaholic/perfectionist. Actually living is amazing!
This comment is offensive!Dear Ann, NP,
This comment is offensive!I very much appreciate your point advocating attention to personal mental wellness, to avoid one family member’s suffering extending to the whole family. Thanks.
[…] psychiatrist Dr. Luo, clinicians’ comments and comprehensive survey results, please visit http://www.epocrates.com/insights/depression. Comprehensive dosing and drug interaction information for anti-depressants can also be found at […]
This comment is offensive!I am a RN with a biology degree, and currently working on my MBA. I am scared to admit to anyone I stuggle with depression. My only living parent died and within two weeks I was in the hospital with meningitis, ICU, in acidosis, O2 sats in the 80’s and I remember the doctors telling me I had gone into CHF. Spinal fluid with elevated WBC’s. It hurt to open my eyes, or turn my head, and I think part of me wanted to go to sleep and not wake up. This was my 10th hospitalization with meninigitis all viral, and all after a stressful event. I have never had a PCP ask me about depression, rather I have said to them I am stressed. The point of this is, even with the stress of daily living and a few significant events, a professional and one willing to look at depression in others and accept it, I find I cannot accept it in myself. So I work long hours, study, and don’t allow myself time to rest, for fear of not being able to stop crying if I let myself feel. Why is it that we can accept dx but not depression? My first husband died of an heart attack, my only child/daughter rejects me, because to her, I loved my work more than her, and I resently left my second hushand to move near my daughter and start a MBA education while I work full time as a Hospital Dir. Again, symptoms = stay busy, don’t feel, it will hurt to much.==Point we can talk about it, but even we professionals cannot accept it(depression) all to often.
This comment is offensive!Depression is the most terrible condition, it affects ones whole life and those of family and friends too.
This comment is offensive!There just are just not enough safety nets to help people with depression,and because of the stigma still attached to that condition some people try to struggle on alone until it sometimes gets too unbearable and sudical.
Whilst I do not suffer from depression I have seen its effect.Sometimes people are perscribed tablets that zombiefy them. and also have to live with society labeling them. Depression comes in all shapes and sizes and can sometime be triggered off by a severe emotional upset. It is not a perfect world that we live in so some people feel the need to hide depressions to avoid labelling.
I have a son who had at age 20 had his fist episode of clinical depression in college. He is a talented athelete and played college basketball. He is doing well now throguh medication but of course I worry about him as my mother also suffered from depression throughout her adult life. ]He had a serous concussion in high school playing football and a study I just read indicated that about 25 per cent of NFL football players who had mutilple concussions suffer from depression. Have any of you had a serious concussion?
This comment is offensive!In response to Sarah M, I have a strong family hx of depression and married someone who suffers from clinical depression. In some ways, I think that depreassion is a contagious disease, it certainly affects the entire family.I firmly believe that the best way to support my spouse and family ( and patients) is to maintain a high level of mental wellness myself. Depression is a medical problem like many others — one needs to find the most beneficial therapeutic option and employ that to the best of your ability. Specifically, finding an excellent doctor and/or therapist who is knowledgeable about all treatment options is KEY.
This comment is offensive![…] Follow this link to Epocrates survey. 90% of clinicians noticed symptoms of depression in 20% … […]
This comment is offensive!I am a health care professional who has been employed off and on for the better part of over 30 years. Yet, I have struggled with major depression that comes in a cyclic mode, staying 6-8 months out of the year since early adolescence. During my teen years, I made 5 suicide attempts - 4 by lethal levels of overdoses that nearly salvaged my kidneys, and once by a near drowning. I now own a gun which is carefully packed away less anyone else should find it, but is there for me if I should ever completely tank again. I blew three marriages, had a couple of bankruptcies, and made my spouses miserable and my children happy to leave home. I spent 20 years going in and out of psychiatric hospitals and living in what seemed to be a bottomless abyss of desperation. Finally, one of my doctors got the right pharmaceutical mix and dose, although it’s much higher than anyone, including the manufacturer, would have recommended. I still struggle with depression. One day, my liver may rot from the long term medication use. I will gladly take the risk and if my liver gives up someday, I will still have had more than I had before. In the meantime however, I have a life. I have a marriage that’s no better and no worse than than of my co workers. I am able to go to work daily, look people in the eye, smile and be of service to others. My own patients get better because I am no longer so cognitively impaired by my depressive mental illness. Yet my current PMD is appalled at my medicine regimen and can barely disguise his contempt for such a medication regimen and for the lack of sanity he perceives must go with it. At this point in my life, what he thinks really doesn’t matter any more. He didn’t live in my shoes. He is so clueless he thinks cancer and such ilks are the worse kinds of pain. Wake up my physican comrades and listen to your patients. You might learn something. You might find out that most mental illnesses have physiologic origins and like diabetes, cancer, strep and gallstones, need to be treated with the same respect. Whether the answer for your patients lies in drugs or in some alternative modality, the bottom line is what it takes to get them better. Frankly, I wouldn’t care if my doctor danced around a campfire of smoldering chicken feathers if that what it took to feel better.
This comment is offensive!I have had many experiences with depression in my own family and with my patients, but two weeks ago I had the most eye-opening experience of my life. My ex-boyfriend and best friend called me at 3am expressing that he wanted to end his life. He was ironically scheduled the following day to see his PCP and discuss anti-depressants.
This comment is offensive!Being 6 hours away, I did what I knew was best to help him by calling his parents. He was placed on Celexa and Ativan prn, but refuses psychotherapy because he feels it is not necessary. I am sure this is not the only case of a 20-something male feeling depression/suicidal ideation shows “weakness” and refusing treatment. I am worried the pharmacotherapy will not work alone without some sort of counseling.
I am grateful that I happened to open this email and have seen some of your comments. I am hoping the idea of acupuncture may work as well. Anyone else have any other suggestions to getting a stubborn, proud young male to see depression and, furthermore, therapy is not a sign of weakness?
People who point to lifesyle change to reduce stress and depresssion miss a very important point.People have different abilities to deal with stress. Some patients may have very few coping skills.
This comment is offensive!Pharmacotherspy allows people to regain the ability to deal with their depression and participate in everyday life.Once they begin to improve then they can use a combination of counseling and medicine to treat their depression.
Most depressed people are ill enough that they can not plan, function, or participate in lifesyle changes.
An analogy would be an overweight person with severe hypertension.If you stress weight loss only without antihypertensive therapy,you may end up with severe end oragan damage.
I have heard of many people having great success with acupuncture. It is proven to boost the immune system and heighten awareness to the triggers leading to disconnects. It worked for me and there are zero side effects!
This comment is offensive!I have been treated for depression for at least 15 years using three drugs. My major symptom has been fatigue though I have had suicidal ideation in the past. The fatigue has been so overwhelming that I have had to take naps at work. Provigal prevented me from falling asleep at the wheel. Ten years ago I had two small strokes and had an ASD closed.
I finally asked for a second opinion dispite the fact that my psychiatrist was very helpful and supportive. He left for another job and I felt it time to try a second practise.
My second opinion suggested that I get a sleep study. I have severe sleep apnea and am now on CPAP. My fatigue is virtually gone. I am off CPAP, Ambien, and my estrogen replacement. I continue to take the Lexapro and Wellbutrin My sleep index score is high enough to explain the increase in my pulmonary pressures to cause the paradoxical clots passing.
Please spread the word that sleep studies should be part of the work-up for depression associated with fatigue especially if it is unresponsive to antidepressents.
This comment is offensive!I have struggled with depression since age 12 and I’m now 40. I was diagnosed with Major Depression for 15 years before I was correctly diagnosed as Bipolar II. My medications have given me firm ground to stand on as I keep trying to get better. I wouldn’t live without my meds. As an RN, I fully understand their benefit. I HAVE made some lifestyle changes such as a lower stress job that fits my personality (this is easier to do for a nurse I realize), regular exercise, eating healthier. Despite all of this, I can’t prevent the depression from returning, but I can say that the episodes aren’t as severe, and for that I am grateful. I feel it’s up to each person to decide what the best course of treatment is for him/her. One thing doesn’t work for everyone, but if you can find what DOES work for you, then by all means, DO it!
This comment is offensive!Depression secondary to medical conditions(very commonly severe back pain or chronic conditions) have been among the most difficult for me to treat. I always ask about and recommend certain life style changes to help reduce stress. However many people dont have physical activity as an options in addition many of these patients are very hesitant to start pharmacotherapy.
This comment is offensive!I am not a physician, but an RN who was placed on Effexor XL to determine if it would help chronic pain resulting from a back injury/surgery three years ago. Withim a few days I was falling asleep without any warning–like a Narcoplexia pattern. I totaled my car. It affected me cognitively in a neg way and was often unable to complete sentences or remember what I had been saying. My friends said I was a different person altogether. Naturally, I stopped this med rather quickly and the symptoms did not return, but it made a mess of my life and I am unable to afford a car due to income restrictions secondary to my disability. I understand, as with all medications, people react in various ways, but for me it was like taking poison and it was slowly killing me.
This comment is offensive!Pharmacotherapy (passive therapy) and life style change (active therapy) provided comfort for both patient and doctor.
This comment is offensive!