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To treat severe or complicated depression, turn to a mental health specialist; a psychiatrist or psychologist. Here's why.
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.
Dr. John Greden says, "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." |
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"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 "Depression to me was somebody walking around moping, sort of withdrawn.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."
His internist, Dr. Rick Cohen of nearby Midland Park, prescribed an antidepressant. It did not take Mr. Smythe long to start feeling better. "I could stay rational without getting annoyed and slamming the phone down," he said. "It turned me around."
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 for depression" 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.
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