Depression is a mental disorder that impacts between 7 and 8 percent of Americans. But most people in the United States seek out treatment not from a specialist — as they would readily do for cancer — but from their primary care doctor.
Recently, a study in the journal Health Affairs complained that primary care physicians don’t treat depression like they would other chronic diseases, like diabetes.
But is depression always a chronic condition? Should doctors treat it more like diabetes? Or should they instead treat it more like a serious condition in need of specialist care?
While most people who get a single episode of depression are at greater risk for future episodes of depression, I don’t believe that makes it a “chronic” condition. Rather, it’s more like a condition that may flare up from time to time in a person’s life… Not something a person needs to be constantly monitored for. And most people’s depressive episodes last an average of about 6 months — not years.
So it’s not surprising that I find the idea that depression should be treated like a chronic medical disease a bit simplistic. Depression is not necessarily a chronic condition in everyone who has it, so a “one size fits all” treatment strategy seems like the exact opposite of the future of healthcare — personalized medicine.
For people who have depression, they have just a handful of episodes of depression in their entire lifetimes — hardly a typical “chronic” medical condition. These episodes need focused, personalized treatment during the time the person is experiencing them.
But if most people are seeking treatment for their depression from their family doctor — as most Americans mistakenly do — what’s a physician to do?
According to the NPR Shots health blog, doctors should follow the same guidelines they would for other chronic diseases like diabetes, asthma and congestive heart failure:
These include employing nurse care managers; keeping a registry of all patients with a condition that requires regular follow-up; reminding patients to comply with their treatment regimens; teaching them about their illnesses; and giving doctors feedback.
Of course, most physicians don’t do these things for their patients with depression.
But I’d argue that’s perfectly fine. Because most Americans are selling themselves short by getting depression treatment from their primary care physician in the first place. You wouldn’t seek out cancer care from your primary care physician, so why would you expect high quality mental health care from them?
Mental illness and mental health issues require a specialist — professionals who have the extensive training, experience, and background to understand your condition and its optimal treatment. If you don’t see a specialist, you’re settling for sub-optimal care.
The answer to the primary care problem isn’t to turn regular doctors into better mental health professionals — that’s not their job. They’re never going to be able to offer the level and standard of care a psychologist or psychiatrist can. That’s not what they’re there for.
Instead, their job should be to refer patients to a mental health specialist, and then ensure the patient keeps the referral appointment through followup.
I think that if the future of healthcare is personalized medicine, that means getting treatment from the health care professional who is able to provide the best care. Not just the most convenient or quickest care, because that care will nearly always be inferior. Not because the physician doesn’t care, but because the physician is simply not equipped to provide the gold standard of care depression requires.
Instead of fixing this problem in doctor’s offices, I’d suggest we need to raise people’s expectations for care in the treatment of their depression. Don’t settle for a hurried doctor’s visit from someone who is well-meaning but no specialist in mental health.
Instead, do what you would do for yourself or any loved one who is suffering from a life-threatening condition like cancer. Go see a specialist today and get the gold standard treatment for depression. In most cases, that’s a combination of psychotherapy along with medications.
Read the Shots article: Primary Care Doctors Often Fall Short In Treating Depression