Can My Primary Care Doctor Treat My Depression?

The short answer is maybe.   There are many factors that influence the success of treatment for depression. First of all, how severe is the depression? Are you still able to function in day to day life? Are you going to work, taking care of your children?  If so, your primary care doctor may be able to put you on an antidepressant medication that will significantly help. Most primary care doctors have a good, basic understanding of common antidepressant medications, and if your depression is relatively mild, that may be good enough.  However, treatment of depression is not always that simple. Your primary care doctor (PCP) is busy. Most PCP’s see 30 to 50 patients per day. They don’t have time to really talk at length about what is going on with you emotionally.

If your depression is more severe, and especially if you have any suicidal feelings, the PCP alone may not be enough. If you have good access to your PCP, that is a start, but your PCP may want to refer you to a mental health professional. Some primary care doctors are now integrating mental health practitioners into their practices. That makes mental health care so much more accessible. Some people hesitate to see a mental health professional because they don’t know where to start.  Should you see a social worker, psychologist, or a psychiatrist?  Hopefully, your PCP can help you navigate through the system and figure out what referral is best.

There are some reasons why you might want to consider seeing a mental health professional initially. Not everyone responds to medication. Sometimes the initial antidepressant medication doesn’t work and needs to be switched. This takes time and patience on your part. What do you do in the meantime? Mental health counsellors can provide some support during that time. Most recent studies have shown that the best treatment for depression is a combination of some type of “talk therapy” and medication.

Sometimes the best therapy might be counselling rather than medication. Many patients see their PCP and simply say “I’m depressed.”  They receive an antidepressant medication. In reality, there may be a problem in their lives such as marital issues, abuse, addiction. Sometimes patients don’t disclose this to a primary care doctor, and the busy doctor may not always probe.  Medication alone does not always get to the underlying issues that need to be resolved.

 

Here is a guide to help you get started:

 

  • If you are suicidal and don’t know where to turn, the emergency room of your local hospital is always an option. They should be aware of psychiatric facilities in your area.
  • The National Suicide Hotline number is 800-273-8255.

 

  • If you live in a town with a medical school, they almost always have a department of psychiatry. You can start by calling them and asking about their outpatient clinic.

 

  • You can google therapists in your area. Simply search therapists in (your city), for example type therapists in Louisville in your search bar. You will get a combination of mental health practitioners, social workers, psychologists, psychiatrists.

 

  • Psychiatrists can prescribe medication, make certain that there are no medical causes for your depression and provide counselling. Some psychiatrists mainly provide medication management and refer to social workers or psychologists for therapy.

 

  • Psychologists and social workers provide psychotherapy (counselling) Some may specialize in seeing families or children. Most psychologists and social workers have a psychiatrist that they refer to if medication is needed. You can always start with a therapist and then see a psychiatrist for medication later if necessary.

 

Treatment works best when your providers collaborate. Your therapist, psychiatrist, and primary care doctor should be communicating with each other.

 

Don’t simply ignore your depression. It’s a signal, a red flag.  Pay attention.

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Loneliness in a Connected World

 

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I’ve been thinking a lot about loneliness and isolation, one of the most common topics my patients discuss. We live in such a technologically connected society, yet many of us don’t feel connected. Why, in spite of texting, Facebook, Skype and FaceTime, is isolation such a common theme? I don’t have a clear answer, but based on what I hear on a daily basis, many people still feel disconnected from society. I interpret that as loneliness.

I have a love/hate (mostly hate) relationship with Facebook.  My step-daughter lives in Chicago. My daughters, her half sisters, are much younger than she is, yet they are able to keep up with her life and her with theirs through Facebook. I’m convinced that Facebook has been good for their relationship.  However, I have seen so many families play out their dysfunctional dynamics on Facebook. The absence of direct contact with the person we’re angry with gives us license to say things we would never say in person. I’ve seen more families end relationships that probably could have been worked through after a tirade on Facebook.

It seems to me that electronic communication makes it so much easier to judge people without really knowing them. I’m not against electronic communication, but I do think that it has some fall-out. Judging a particular person or group of people based on what we see in the media creates distance, an unwillingness to see for ourselves. It is impossible to really know someone unless you’ve talked with them face to face. So much of what I hear on the “news” is really opinion in disguise, not fact. It’s often slanted in a certain way depending on the bias of the station.

I’ve come to realize that you have to work at not being lonely. People will not knock on your door and ask to be your friend. As I’ve gotten older, I have a better understanding of why people stay in their hometown area. They have a social structure, they don’t have to go out and make one. However, for those of us who have moved around (several times), it’s harder to re-establish that social structure in a new place. This is particularly true as we age. Younger families have children in school. Parents can easily meet other parents at school functions, scout meetings, dance lessons, etc. How do you make true connections with people when you have no children, perhaps have financial limitations, and may or may not have a significant other in your life?

For many, church can be a meeting place. However, I have found that this is not fool-proof. You have to find a church that fits your value system. Some churches are better at incorporating new people than others. Some have more social activities than others. It takes effort and patience to find the right fit.

It’s always good to meet your neighbors. In my experience most neighbors are quite well-intentioned and happy to meet the new occupants next door. However, especially in very established neighborhoods, they may not reach out beyond a pleasant “hello.” I don’t think they are intentionally avoiding new people. They just have their set routine. Many times, they’ve lived in these neighborhoods for years and have established friends. However, they are usually quite willing to come over for dinner or have lunch if you ask. Unfortunately, today it seems that you have to invite people into your world. Gone are the days of Donna Reed making an apple pie to take over to the new neighbors. No more sitting out on the front porch watching the neighbors walk by and waving hello. I think we’ve lost something when it comes to real face to face communication with people.

Another avenue to friendship might be volunteering. You are likely to run into people with similar values since you choose where you want to volunteer. Volunteering can put you in touch with the real world. You see how much need there is.  I believe that volunteering can be helpful for people who are depressed, grieving, struggling with meaning in life.  It helps us focus on others, not ourselves.

Rather than viewing the world through the eyes of CNN or Fox News or MSNBC, consider getting out there and connecting with people directly. It’s far more satisfying. Facebook is great but it doesn’t take the place of talking out those conflicts or getting in the car and visiting your family in person.  When I opened my browser today (yes I do still read the news on my computer), I saw the article about Pope Francis’s new paper. The headline read “More tolerance – less judgment.” Yeah Francis. I don’t agree with everything in the paper (still no OK for birth control), but I certainly do agree with that. This is my challenge to you for the next week. Find someone who seems lonely or isolated. It shouldn’t be difficult because there are millions of people out there who meet the criteria. Take someone to lunch or the grocery, or just go have a cup of coffee and talk to them. If it’s someone very different from you culturally, that’s even better.

I love this quote from Sylvia Plath:

“So many people are shut up tight inside themselves like boxes, yet they would open up, unfolding quite wonderfully, if only you were interested in them.”

Sylvia Plath, Johnny Panic and the Bible of Dreams: Short Stories, Prose and Diary Excerpts