Although depression is a highly treatable illness, it can become more difficult to treat the longer it goes undiagnosed or undertreated. A new survey of 2,001 adults living with depression found that many of these individuals engage in unhealthy behaviors that may jeopardize recovery. The survey was part of a new depression educational program called Missing Pieces, which was developed by leading mental health experts and supported by Eli Lilly and Company to help people identify the information patients need to better understand depression.

Analyzing Key Findings

According to the survey, it took an average of about 6 years for respondents to seek diagnosis from a healthcare professional. “An alarming finding was that 57% of patients surveyed waited more than 6 months to get depression treatment,” says Thomas N. Wise, MD, who was on the multidisciplinary expert panel that helped shape the development of the survey as well as educational materials for the Missing Pieces program (Figure 1). “Social stigma, embarrassment, and negative reactions often play a role in delays for seeking treatment. The survey highlights the need for more public information on depression and its symptoms. Patients need to become more aware of the symptoms so that they seek treatment earlier.”

Among survey respondents who waited 6 months or longer to be diagnosed, 69% reported delaying their diagnosis because they lacked knowledge about depression or basic facts about available treatments and where to get help. Although 91% of the survey population had been prescribed an antidepressant, only 7% of these individuals felt very knowledgeable about the basic aspects of their treatment. “Patients are missing pieces of vital information that may prevent them from getting well,” says Dr. Wise. Compounding the problem is that 57% of patients who delayed seeking a diagnosis felt they could manage depression symptoms on their own.

Ongoing Communication Warranted

Many adults with depression do not discuss important information related to their treatment plan with their healthcare provider, according to the Missing Pieces survey. Nearly two thirds (62%) of respondents reported that they thought it was possible to recover completely from depression, but 64% did not fully understand what it means to actually “get well.” About two of every five individuals (41%) who stopped taking antidepressants did so without telling their doctor.

“To increase the likelihood of recovery from depression, it’s important that patients are put on a comprehensive treatment plan that may include medications, psychotherapy, and lifestyle changes,” Dr. Wise says. “The goal is to help them to recovery and avoid the potential for relapse. It’s important to recognize that there’s a difference between getting patients to ‘feel better’ and getting patients back to baseline, living depression-free.”

A Three-Step Action Plan

One component of the Missing Pieces program was to develop three simple steps to help guide patients with depression from diagnosis to recovery (Figure 2). “The stepwise approach involves getting a rapid diagnosis, giving time for treatments to work, and establishing long-term management plans after recovery,” explains Dr. Wise. “In the first step, clinicians should diagnose depression in adults experiencing at least five of the symptoms of depression—based on the Patient Health Questionnaire-9, or PHQ-9—for 2 consecutive weeks. At least one of these symptoms should be depressed mood or loss of interest. The purpose of the PHQ-9 is to quantify the level of depression, similarly to how physicians would quantify the level of hypertension, diabetes, pain, and other illnesses. Developed by Kroenke et al, the PHQ-9 has been shown in clinical investigations to be reliable and easy to use for clinicians and patients [Figure 3]. The assessment is quick to implement and well-tolerated by patients. It’s also easy for clinicians to score and make a diagnosis.”

 The second step of the Missing Pieces action plan is for clinicians to give 6 weeks for depression treatments to take effect. “Antidepressants take time to work and there are side effects to consider,” Dr. Wise says. “Patients need to be counseled about the importance of adhering to their treatment plans; they should be discouraged from discontinuing medications early. Oftentimes, patients will see results more quickly if they take medication, receive psychotherapy, and make appropriate lifestyle changes rather than utilizing only one of these approaches, but every patient will react differently to their treatment plan. The key is to get patients to recognize and understand that it may take more time than they would prefer to get the results they desire, but it’s a worthwhile effort.”

In the third step, clinicians are recommended to manage depression treatment plans when patients feel better. “If patients are satisfied with their treatment and their depression is improving, they should continue on that treatment for at least another 4 to 9 months to help prevent relapses of symptoms,” says Dr. Wise. Some individuals will also require long-term maintenance treatment to help prevent future episodes of depression.

Guiding Your Patients

In addition to the three-step plan, Missing Pieces offers an educational website, found at, which provides more survey details and in-depth information about depression for clinicians and patients. “The Missing Pieces program takes a rational approach to the diagnosis and treatment of depression,” Dr. Wise says. “Patients are informed on what to expect as their depression is managed, the available treatment options, and the importance of working with healthcare providers, friends, and family. Ultimately, the goal is to uncover the ‘missing pieces’ and provide answers so that patients are armed with accurate information to best manage depression and its symptoms.”


For more information on the Missing Pieces program, go to The website also provides information on a survey conducted online within the United States by Harris Interactive on behalf of Eli Lilly and Company April 23 to May 7, 2009 among 2,001 U.S. adults ages 18 and older who have been diagnosed with depression. 
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