The Undertreatment of Depression
Some of the reasons for this underdiagnosis and undertreatment were mentioned earlier, but bear repeating and elaboration here.
First, it's easy to find a cause other than depression to explain away -- to oneself or others -- depression's symptoms. Hence, the true cause of these imbalances -- depression -- is not considered.
Second, when considering medical treatment, people tend to look for negative symptomspain or discomfort. The notion that "lack of pleasure" might be the symptom of an illness needing medical treatment seldom occurs. If the thought, "I'm not enjoying myself enough," does occur, it is often disregarded by the depressed person -- or by well-meaning but unknowing friends -- as trivial or self-indulgent.
Many people justify their increasingly unpleasant lives by saying, "It's just a phase," "I've been under a lot of pressure lately," or "I must be getting older."
But that is often not the case. Each year more than 30,000 people commit suicide in the United States. Fully seventy percent of these suicides were due to untreated depression. Left untreated, depression's burden of a joyless life accumulates, day by day, month by month, year by year. Depression can become a life-threatening illness.
Third, depression has symptoms people seldom associate with "being depressed." Unfortunately, the term depressed has taken on two meanings -- the medical meaning we have been discussing in this book, and the everyday usage of depression: momentary disappointment, letdown, or discontent. "The 7 - 11 ran out of glazed donuts. I'm so depressed."
Depression, then, is thought of by many as simply feeling low or down. The illness of depression, many people have inaccurately concluded, must be feeling very low and very down. If these people don't feel very low or very down very often, they dismiss the possibility of depression.
Certainly some of the symptoms of a depressive illness are feeling low or down, but one can have a mild to moderate depression without feeling "depressed" much at all.
Such symptoms as sleep disturbance; eating disorders; difficulty concentrating, remembering, or making decisions; drug or alcohol abuse; and especially physical aches and pains are not directly associated with emotionally feeling low, but they can be symptoms of medical depression.
Finally, some people who think they might have a depression do not seek treatment because they feel anxious over, angry about, or undeserving of a cure. In these cases, the very symptoms of the disease keep the disease from being treated.