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Antidepressant Rx: Careful Monitoring Needed

Patients need close follow-up for treatment of clinical depression.
By
WebMD Feature
Reviewed by Cynthia Dennison Haines, MD

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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When you're depressed, muscle aches in your legs and feet can seem to come out of nowhere. They may not be related to any known injury or strain, and certainly need medical evaluation. But depression and physical pain are closely related. Depression makes us more aware of vague aches and pains we would otherwise not notice. It also intensifies the feeling of pain and discomfort. Could your muscle aches be related to depression? One way to find out is to keep a symptom diary. Print out this symptom...

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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."

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