The 3rd APA Treatment Guideline for Major Depressive Disorder is about to be published. Press releases went out late last week. I’m the only person who participated in the writing of all three iterations, and I chaired the work group that wrote the most recent one.
We began in 2006. I was then in Tucson and have since migrated to Madison, WI, and then to Central Pennsylvania and Penn State. It’s been a long four years. First came the scholarship, sifting through myriad papers, studies, and data. Many, many calls and emails. Then came over a thousand comments from colleagues in practice, scientists, and medical directors of companies that made depression treatments. All had to be responded to in multiple drafts and what felt like endless rewriting. Finally, the complex APA hierarchy had to read, discuss, consider, and vote. We’re finally done.
I was surprised by some of the press reaction. ECT was a small part of a very long document, which details a growing panoply of options for treating depressed people: from diet and exercise through therapy and medication and on to various ways to stimulate the brain electrically or magnetically. But ECT, with its echoes of “Cuckoo’s Nest,” evokes emotion and, I suppose, captures readers’ attention.
A blogger for a major news weekly turned the Guideline into a battle between psychiatrists and psychologists. I learned that we hate each other. (Really?)
When Marty Keller and others looked at depression treatment in the early 1980s, they learned that only 20% to 25% of depressed people get minimally adequate treatment. NIMH and various advocacy groups launched campaigns to educate doctors and the public. Managed care was graded by accrediting agencies on how well they diagnosed and treated depression. Now, 30 years later, the percentage of depressed people who receive minimally adequate treatment remains more or less the same.
But what titillates the press is that “shock treatment” remains among our treatments. And that sometimes psychiatrists and psychologists disagree or have guild arguments. To me that’s sad. We need better press agents for improving mental health access and care.