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Antidepressant Rx: Careful Monitoring Needed

Patients need close follow-up for treatment of clinical depression.
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WebMD Feature

Who prescribed your antidepressant? Not a psychiatrist, most likely.

Up to 80% of antidepressants are prescribed by primary care doctors -- and given the high rate of clinical depression, "that's a good thing," says David Feinberg, MD, a clinical psychiatrist with the UCLA Neuropsychiatric Institute.

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In fact, many insurance plans require a primary care doctor be the first step in treatment. "Pediatricians, primary care doctors, and family doctors have always provided a tremendous amount of mental health care," Feinberg tells WebMD. "If they didn't, too much depression would not get treated."

However, the recent FDA warning about antidepressants -- that depression and suicidal thoughts could get worse at certain points in treatment -- concerns many people.

What kind of follow-up care should adults or children get from a primary care doctor? How frequently should they see their doctors? Should patients (or parents) push for more follow-up care? Should a psychiatrist be involved in treatment? Is therapy necessary?

For guidance on these issues, WebMD contacted several psychiatrists. Their advice:

1) Be your own (or your child's) advocate.

Primary care providers can generally diagnose clinical depression in adults. Sadness, difficulty concentrating, sleep problems, lack of energy, and hopelessness are classic symptoms. Discuss them with your doctor, and talk about all the treatment options.

However, with children and adolescents, depression is not so easy to diagnose, says David Fassler, MD, private practice child and adolescent psychiatrist and professor of psychiatry at the University of Vermont.

"Depressed kids don't always look like you would expect," he tells WebMD. "Quite often, they are not sad or withdrawn. They may be irritable, getting into fights, agitated. Getting an accurate diagnosis is key with kids. Some social workers and psychologists are good at recognizing depression in kids, as are some pediatricians and family practice physicians."

A psychiatrist's evaluation is often necessary to determine just what is going on with a child, he says. "Frequently, a child psychiatrist does the initial evaluation and prescribes medication. Then the child is referred back to the pediatrician for monitoring and follow-up, hopefully in conjunction with therapy."

2) Do your homework.

For a short-term episode of clinical depression -- what doctors call mild or moderate depression -- treatment with either medication or therapy alone will usually work, explains Michael Thase, MD, professor of psychiatry at the University of Pittsburgh School of Medicine and author of the book, Beating the Blues.

Both antidepressants and therapy change brain chemistry, which relieves depression and stabilizes mood, research shows. But before making a decision, do some research, advises Feinberg.

"If you're talking about an antidepressant, read everything you can find about it," he says. "Don't allow your child to take an antidepressant that has not been tested and found safe for children."

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