Challenges and Costs Associated with Major Depression

Las Vegas—Major depression disorder (MDD) is the most common psychiatric disorder in the United States, but few Americans with MDD receive optimum treatment, according to Ken Hopper, MD, executive consultant at BHM Healthcare Solutions, a consulting and advisory firm.

During a session at the Fall Managed Care Forum, Dr. Hopper said inadequate treatment can lead to other medical disorders and can be associated with functional and structural changes in the brain.

Dr. Hopper said depression is the leading cause of disability in the United States, and by 2020, it will be the leading cause of disability in the world. In the United States, 19 million adults (9.5% of the population) suffer from depressive disorders, and the age of patients is decreasing. Fifty years ago, the average age of onset of depression was 29 years, compared with 14.5 years today.

The lifetime prevalence of MDD is 17%, corresponding to between 32.7 million and 35.1 million adults having the disease at 1 point during their life. Approximately one third of major depressive episodes last >2 years, and 50% of patients will experience a recurrence within 2 to 3 years of recovery. Dr. Hopper said morbidity associated with major depression is similar to angina and advanced coronary artery disease.

The disease poses an economic burden, as well. In 2000, the costs associated with major depression totaled $83.1 billion: 63% attributed to missed work, 31% direct medical, and 7% related to suicides. By 2020, MDD will be the second most costly disease behind ischemic heart disease, according to Dr. Hopper.

Dr. Hopper cited a survey of employers that found depression ranked seventh among conditions that drive medical costs and is the leading cause of productivity loss among workers. Each year, approximately 217 million days of work are lost due to mental illness and substance use disorders, costing employers $17 billion.

Of patients diagnosed with depression, 69% reported unexplained physical symptoms as their chief complaint, according to a study that Dr. Hopper discussed. MDD is also commonly found in patients with other conditions. For example, 28.5% of patients with diabetes meet the criteria for clinical depression, according to Dr. Hopper, while chronic pain is also typically associated with depression. He added that healthcare utilization and costs are twice as high in patients with diabetes and heart disease who also have depression compared with those without depression.

Studies have found as many as 70% of patients respond to treatment for depression but then fail to achieve remission from emotional and physical symptoms. Therapeutic options include serotonin selective reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, and adjunct therapies such as atypical antipsychotics and mood stabilizers.

However, Dr. Hopper said that 75% of people stop taking antidepressants by month 4 of their treatment regimen, so it is important to educate them about the disease.