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Depression Depression Treatment

Can Primary Care Doctors Treat Depression?

Years ago, if someone thought about mental health care, he or she might have imagined a pipe-smoking psychiatrist listening to a reclining depressed patient from his leather armchair. But in reality, depression is more likely to be treated by a primary care doctor who might not have time to sit down at all.

Identifying and treating depression is challenging, especially when time and resources aren’t available. And there are concerns that depressed patients do not receive the proper attention when they are treated by a primary care doctor instead of psychiatrist. But some experts disagree and say that the primary care setting has the potential to help people find long-term relief from depression.

Why Depression Is a Primary Care Problem
One reason researchers are interested in improving mental health care in primary care is that, currently, most men and women with depression are not receiving treatment. This was confirmed by results of a 2003 national survey on major depression, which showed only about half of people with major depressive disorder received treatment.

Before patients can get treatment, someone has to recognize that they are depressed—and that job usually falls to the primary care provider.

"Most people don’t see a mental health professional even if they have major depression or anxiety, so the primary care doctor is often the only point of contact," says Dr. Donna McAlpine, an assistant professor at the division of health services research and policy at the School of Public Health at the University of Minnesota. "We want to make sure more primary care doctors recognize depression and anxiety in their patients."

Research suggests that once depression is identified, most people stick with their primary care doctor for treatment.

"People are comfortable with their primary care doctors," says Dr. Kenneth B. Wells, center director at the University of California, Los Angeles Neuropsychiatric Institute and Hospital. "We’re all creatures of habit, and there’s still a stigma attached to getting mental health care."

Additionally, Wells says, psychotherapy with a mental health professional is rarely covered appropriately by insurance. And even if people do have adequate insurance coverage for mental health services—and they obtain a referral—they end up not going. Moreover, in some parts of the country, mental health professionals are hard to find.

Is It Good Enough?
Fortunately, depression is more likely to be picked up in primary care office today than it was in the 1980s and 1990s. According to McAlpine, doctors can often identify people who are at high risk for depression with a couple of simple questions, such as "Over the past two weeks, have you felt down, depressed or hopeless?" and "Over the past two weeks, have you felt little interest or pleasure in doing things?"

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