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.
When Orion Lyonesse is getting depressed, she turns into a hermit. She doesn't want to leave the house (not even to pick up the mail), and she cuts off contact with her friends and family.
"The more I'm alone, the deeper the depression gets," Lyonesse, an artist and writer in Lake Stevens, Wash., tells WebMD in an email. "I don't even want to cuddle my cats!"
Avoiding social contact is a common pattern you might notice when falling into depression. Some people skip activities they normally enjoy...
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 "Quite often, they are not sad or withdrawn.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."