For Depression, The Family Doctor May Be The First Choice But Not The Best
Q: For most of his life, John Smythe of Glen Rock, N.J., struggled with a hot
temper during day and insomnia at night. He thought of these problems as
family traits; his parents had them, too. But two years ago his internist
told him that they were signs of clinical depression.
"A chill went down my spine," recalled Mr. Smythe, 60, who runs a small
business. "Depression to me was somebody walking around moping, sort of
withdrawn. It never occurred to me that there could be other symptoms."
A:Mr. Smythe is in a lucky minority. Only about 40 percent of people in
treatment for depression get adequate care, according to a survey of more
than 9,000 Americans that was sponsored by the National Institute of Mental
Health and released last week.
The study defined "adequate treatment" as a course of at least 30 days on an
antidepressant or a mood stabilizer, along with four visits to a doctor or
at least eight 30-minute psychotherapy sessions with a mental health
professional.
Dr. Ronald Kessler, a professor of health care policy at Harvard who was the
lead author of the study, says a crucial problem is that general medical
doctors tend to be the first line of defense against mental disorders as
well as physical ones. Because they are not as well informed about
depression as mental health specialists, he said, they are more likely to
undertreat it — prescribing either too little medication or an inappropriate
one, like an anti-anxiety drug.
These general practitioners, typically family doctors and internists, treat
70 percent of the people who seek help for depression, according to other
research. And more of them are treating depression now than a decade ago,
Dr. Kessler said, because the newer antidepressants — selective serotonin
reuptake inhibitors — are safer and easier to prescribe than older drugs.
"The companies that make these drugs are providing more educational material
to general medical doctors," he said.
Psychiatrists say the new findings should not be interpreted to mean that
primary-care physicians are unqualified to treat depression.
"The notion that everybody with depression should be treated by a mental
health professional is ridiculous," said Dr. John Greden, a psychiatrist who
is director of the Depression Center at the University of Michigan.
Dr. Greden said many general practitioners could effectively treat people
with mild to moderate depression. But he added that mental health
professionals agreed that severe or intractable depression should be
referred to a psychiatrist or a psychologist.
"Just as you wouldn't want a primary-care physician to do coronary bypass
surgery, you wouldn't want one to treat severe or complicated depression,"
said Dr. Greden, who works with primary-care doctors in Michigan on ways to
improve the diagnosis and treatment of depression.
They are though. Most of them at least. I once had a 'primary-care
physician' prescribe me an anti-depressant for depression and he told me:
"it isn't going to help you feel any better, you'll have to do that
yourself", well then why the hell are you prescribing it to me you stupid
ahole, if that's your attitude why not give me a sugar pill? (and by the
effectiveness of the anti-depressant he gave me, he just may have)
I tried to get the idiot