Whether they come through a public service campaign or a pharmaceutical commercial, messages about depression always end the same: Talk to your doctor. But new research begs the question of whether or not that works.
About one in 10 people report symptoms of depression at some point in their lives. But general practitioners may not be well equipped to diagnose or treat the common condition: Fewer than 3 percent of primary care visits include screening for it, according to national data from the Centers for Disease Control and Prevention.
Even more: As many as one in four depressed patients who visit a primary care doctor remain undiagnosed at the end of their appointment.
Pointing the Finger
Some of the blame falls on your doctor--and the medical system in general. "Not all physicians recognize that depression can manifest in different ways--as fatigue, chronic pain, or especially in men, irritabilit y," says Richard Kravitz, M.D., a professor of internal medicine at the University of California Davis School of Medicine.
Medical training typically instills a focus on the five-minute physical--and your doctor may not have time to explore your emotions after checking your blood pressure and addressing your main complaints, says Philip Muskin, M.D., a professor of psychiatry at Columbia University Medical Center. Even if he does suspect your physical symptoms have psychological roots, your doc may fear offending you by bringing it up.
That concern makes sense: "Depression carries stigma; many think it conveys weakness," Dr. Kravitz says. "Some patients think mental health issues are outside the domain of primary care and don't want to distract the doctor from treating their physical condition."
On the flip side, primary care doctors sometimes pull out the prescription pad too quickly. In a study Dr. Kravitz just published in the J ournal of the American Medical Association, 3 percent of patients without depression and up to 10 percent of patients with mild depression were prescribed antidepressants when the drugs work best for people with moderate to severe symptoms.
Your Guide to Getting Help
So how can you help your doc? In the same JAMA study, Dr. Kravitz found patients who were briefed about depression before a doctor's appointment were more likely to bring up the condition and receive a treatment recommendation.
If you think you could be depressed, read up on the symptoms on the American Psychiatrics Association's website. While some are severe--like the thought of harming or killing yourself or others--and need immediate attention, other signs are much subtler: being unhappy most of the day, drinking more, losing interest in your girlfriend or your friends, having trouble sleeping, weight fluctuations, and concentration issues. In fact, the people around you may start asking what's wrong. If they do, pay attention.
Once you're in the exam room, explain what you feel and ask your doc: "Could it be depression?" "The answer may be ‘no.' But simply asking will cue your physician to explore the issue further," Dr. Kravitz says.
If the answer is yes, start with a referral to a psychiatrist. Primary care physicians don't do therapy, nor do they know as much about antidepressants as the average shrink. And though psychologists, social workers, and pastoral counselors are well-versed in therapy, they can't prescribe. Having the option for either route will help you and a medical professional figure out the best course of action--then fine-tuning your treatment can help avoid side effects while getting back to your old, happy self, Dr. Muskin says.
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