Knowing that most people initially seek out treatment for their mental health concerns through their general practitioner or family doctor, you have to wonder how many of them feel about being the front line in the war on depression and such.
Dr. Rob is such a physician and wrote an entry today about dealing with patients who present with symptoms of major depression. Does he just prescribed the asked-for antidepressants and send them on their way? Thankfully, he does not:
Having observed people over the 14 years I have practiced, I think that there are times when it is actually to the person’s detriment to take medication. I am not referring to the potential of adverse events or side effects, but more to the fact that it is not always good to avoid going through hard times. This is difficult to get across to the patient, however, and runs the risk of coming off sounding patronizing.
To help me get my message quickly to patients, I have developed several illustrations that explain depression and my approach to it.
1. Medications for depression are like a prop that holds a wall up that is falling down. If you hammer on the wall before you put the prop up, you may knock the wall over. The prop is important to stabilize things. Some people, however, are content to put the prop up and call the problem solved. Taking medication alone makes it possible to do what needs to be done to find out what is really causing problems.
2. If someone comes to my office with chest pressure, I don’t simply give them pain medications to make their symptoms go away. In fact, treating the pain may actually harm the person by giving them a false sense of everything being OK. The pain is there for a reason, and finding out why it is there is more important than making it go away.
I’m glad to read some docs recognize their own limitations and understand how to beneficially help their patients, while recognizing that the prescription of a medication is just the first step on a healing journey.
Dr. Rob is alright in my book!
Read the full blog entry over at Musings of a Distractible Mind.
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6 Responses to “A GP’s Take on Treating Depression & Anxiety” (Pingbacks/trackbacks not shown below)
Why, Thank you! It is nice for my Psych colleagues to agree with my approach.
kat-missouri at 2:37 pm on
May 31st, 2008
Dr. Grohol,
I was on the call with you on Thursday with the DOD re: mental and behavioral health.
One of the things that I was concerned about, that I don’t believe received a good answer, was in relation to Dr. Rob’s post: anti-depressants being prescribed in the field by field physicians without a significant psychiatric diagnosis and without any ideal follow up in the field or upon redeployment back to home base.
As you note from Dr. Rob’s blog, it does happen in the civilian world considerably more than people would like to admit and I believe that it is the same for the military in the field or possibly even at home. I believe that based on anecdotal evidence and the observance of civilian health care.
I want to approach the DOD on this subject and wondered if you could point me to any statistical information regarding the prevalence of prescription anti-depressants through general practitioners and other non-psychiatric physicians.
I believe that there IS a gap in our identification of and treatment of depression and other conditions that lead to major depressive episodes and that it exists in the military. I think this is very interesting because, in essence, the military has a captive patient base, so to speak, and certainly has extensive access to data and medical records, even in the prevailing sense of patient privacy.
I think they are missing an important piece of preventive care if this is indeed being ignored.
I don’t want to play “gotcha” with the military, but I do want to follow up with some questions to Col. Richie, et al and would like to be well armed with information to make informed inquiries. Thus, any assistance you could provide in pointing to this statistical information would be greatly appreciated.
Please contact me at kehenry1@hotmail.com.
Sincerely,
Kat Henry
thedonovan.com
(Castle Arrggh)
John M. Grohol, Psy.D. at 6:26 am on
June 1st, 2008
Sadly, I could find no more recent data than this study, published in 1998, after a cursory literature search. I may have more time later to search further:
Pincus, HA, Tanielian, TL, Marcus, SC, Olfson, M, Zarin, DA, Thompson, J, & Zito, JM. (1998). Prescribing Trends in Psychotropic Medications: Primary Care, Psychiatry, and Other Medical Specialties. JAMA, 279, 526-531.
http://jama.ama-assn.org/cgi/content/full/279/7/526
Their findings, for all psychotropic medications (not just antidepressants) were than psychiatrists prescribe about 33% of such meds, while primary care physicians and other specialties account for the other 66%.
And while the overall number of office visits that result in a psychotropic medication have, I believe, increased since this data (it looks at data from 1993-1994), I wouldn’t be surprised to find the percentages are largely the same.
Wendy Aron at 10:53 am on
June 2nd, 2008
I think it makes sense for a GP or internist to recommend that a patient see a mental health professional, get a commitment that she/he will do so and THEN prescribe anti-depressants. I find that these front line doctors often dispense with antidepressants just to get a patient that is incessantly asking for pills off their backs. This is actually a disservice is those who truly suffer from mental illness.
Wendy Aron, author of Hide & Seek: How I Laughed at Depression, Conquered My Fears and Found Happiness
Ann Russell at 8:51 pm on
June 4th, 2008
I am a licensed clinical social worker and am providing mental health services at a Federally Qualified Health Center, which serves people with Medicaid and those with no insurance. I was hired because we could not get patients into the local mental health center in a timely fashion. Our family practice docs prescribe a lot of psych meds and I believe that this is often the case in other medical practices. I would like to write a paper on this, but have been unable to find anything published in this country, until the article cited above. I would be interested in any more articles that could be found.
Treating Anxiety at 4:57 am on
July 29th, 2008
I think that medication are a short term solution. In the long run it’s best to see a practitioner that can help you without the need of medication. However in some severe cases medication are needed and then I recommend the Valerian plant.
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Why, Thank you! It is nice for my Psych colleagues to agree with my approach.
Dr. Grohol,
I was on the call with you on Thursday with the DOD re: mental and behavioral health.
One of the things that I was concerned about, that I don’t believe received a good answer, was in relation to Dr. Rob’s post: anti-depressants being prescribed in the field by field physicians without a significant psychiatric diagnosis and without any ideal follow up in the field or upon redeployment back to home base.
As you note from Dr. Rob’s blog, it does happen in the civilian world considerably more than people would like to admit and I believe that it is the same for the military in the field or possibly even at home. I believe that based on anecdotal evidence and the observance of civilian health care.
I want to approach the DOD on this subject and wondered if you could point me to any statistical information regarding the prevalence of prescription anti-depressants through general practitioners and other non-psychiatric physicians.
I believe that there IS a gap in our identification of and treatment of depression and other conditions that lead to major depressive episodes and that it exists in the military. I think this is very interesting because, in essence, the military has a captive patient base, so to speak, and certainly has extensive access to data and medical records, even in the prevailing sense of patient privacy.
I think they are missing an important piece of preventive care if this is indeed being ignored.
I don’t want to play “gotcha” with the military, but I do want to follow up with some questions to Col. Richie, et al and would like to be well armed with information to make informed inquiries. Thus, any assistance you could provide in pointing to this statistical information would be greatly appreciated.
Please contact me at kehenry1@hotmail.com.
Sincerely,
Kat Henry
thedonovan.com
(Castle Arrggh)
Sadly, I could find no more recent data than this study, published in 1998, after a cursory literature search. I may have more time later to search further:
Pincus, HA, Tanielian, TL, Marcus, SC, Olfson, M, Zarin, DA, Thompson, J, & Zito, JM. (1998). Prescribing Trends in Psychotropic Medications: Primary Care, Psychiatry, and Other Medical Specialties. JAMA, 279, 526-531.
http://jama.ama-assn.org/cgi/content/full/279/7/526
Their findings, for all psychotropic medications (not just antidepressants) were than psychiatrists prescribe about 33% of such meds, while primary care physicians and other specialties account for the other 66%.
And while the overall number of office visits that result in a psychotropic medication have, I believe, increased since this data (it looks at data from 1993-1994), I wouldn’t be surprised to find the percentages are largely the same.
I think it makes sense for a GP or internist to recommend that a patient see a mental health professional, get a commitment that she/he will do so and THEN prescribe anti-depressants. I find that these front line doctors often dispense with antidepressants just to get a patient that is incessantly asking for pills off their backs. This is actually a disservice is those who truly suffer from mental illness.
Wendy Aron, author of Hide & Seek: How I Laughed at Depression, Conquered My Fears and Found Happiness
I am a licensed clinical social worker and am providing mental health services at a Federally Qualified Health Center, which serves people with Medicaid and those with no insurance. I was hired because we could not get patients into the local mental health center in a timely fashion. Our family practice docs prescribe a lot of psych meds and I believe that this is often the case in other medical practices. I would like to write a paper on this, but have been unable to find anything published in this country, until the article cited above. I would be interested in any more articles that could be found.
I think that medication are a short term solution. In the long run it’s best to see a practitioner that can help you without the need of medication. However in some severe cases medication are needed and then I recommend the Valerian plant.
