Primary care doctors can help bridge the gap in mental health care. In fact, they prescribe most antidepressants. But you may wonder if it’s OK to get your depression treatment from your regular doctor.
Gerard Sanacora, MD, director of the Yale Depression Research Program, says primary care doctors can be a good first choice.
"It’s not possible for everyone who’s experiencing depression to see a psychiatrist," he says. "There just aren’t enough mental health professionals to see everybody."
With your doctor’s help, here are some steps you can take to make the most of your treatment.
Most primary doctors are strapped for time. "They have, on average, 8 minutes with each person," says Sanacora. But when it comes to depression treatment, he says there are some key points you should cover.
For starters, he says "it’s very reasonable to ask what the plan is and when you should see results." Here are some other questions you might want to ask:
- What are the pros and cons of different antidepressants?
- What are common side effects?
- If I have side effects, when will they go away?
Keep in mind that it can take time for your body to adjust to the medicine. Sanacora says sometimes, people give up in the first couple of weeks because of unwanted symptoms. But they might be easier to handle if you know what to expect.
"It isn’t so much that the side effects are so intolerable," he says. "It’s that they weren’t told that you may actually feel worse before you feel better."
When to Follow Up
There isn’t one time frame that’s best for everyone. Sanacora says it depends on a few things, like how serious your symptoms are and how well you tolerate your medicine.
If your symptoms are mild, and you start to get better, it might be OK to follow up in 4-6 weeks. Check in sooner if your symptoms don’t budge.
"There’s good evidence that if you’re not seeing any improvement within the first couple of weeks, then you should consider reevaluating," Sanacora says. "That doesn’t mean changing [the drug]. But should you change the dose? Should you reconsider the diagnosis?"
Small improvements can be hard to notice when you’re depressed, and Sanacora says that’s where measurement-based care can be a big help. That’s when you rate the typical symptoms of depression on a scale. You compare the results as your treatment goes on.
Here are some of his tips on what you or your doctor should measure:
- Ability to feel pleasure
- Sleep habits
- Focus and concentration
- Energy levels
- Your ability to start things
- Suicidal thoughts
Follow-Up Care for Kids
When it comes to children, Linda Drozdowicz, MD, an assistant clinical professor of child and adolescent psychiatry at Yale Child Study Center, says there are some other symptoms to watch for.
"Kids can present as irritable when they’re depressed," she says. "They might not look sad; they might seem pretty angry."
Antidepressants come with a black box warning -- they may raise the odds of suicidal thoughts in people younger than 24. There’s some debate about this concern. But Drozdowicz says kids or teenagers should check in weekly at first, either in person or by phone.
It’s normal to worry about suicidal thinking. But that doesn’t mean your child should avoid antidepressants.
"There may be a smaller chance of more suicidal thoughts at the beginning, usually within the first month," Drozdowicz says. "But the risk of going on with untreated depression seems to be higher when it comes to suicide [attempts]. So, in the end, these medications seem to be protective. They can be lifesaving."
But if you ever think your child is unsafe or might hurt themselves, "that’s a time to go straight to the nearest emergency room or call 911," Drozdowicz says.
"That is a life-threatening emergency, the same as a heart attack."
This isn’t an either-or thing. You can try add-on therapy at any time in your treatment. But here are some reasons you might want to try talk therapy:
- Your symptoms are mild to moderate.
- You want to learn skills that will help you avoid a relapse.
- You want a nondrug approach.
Ask your doctor if you can see someone who specializes in cognitive behavior therapy (CBT). That’s a skills-based approach that works really well for depression. It’ll also help you manage everyday problems, like worries at home or work.
"Chronic stress seems to be one of the contributing factors for future depressive episodes," Sanacora says.
CBT and other kinds of talk therapy can help you manage hard feelings. But perhaps the most important thing, Sanacora says, is the relationship you have with your therapist. You need "connection and empathy, the feeling that you have a common goal moving forward," he says.
When to See a Specialist
Most primary care doctors can handle treating mild depression. But you might need to see a psychiatrist if your situation is more complex. That includes if:
You have treatment-resistant depression. You don’t respond to at least two standard antidepressants.
You need help with side effects. It’s not uncommon for antidepressants to make you feel more anxious or "activated" at first. You may feel unbalanced or have trouble sleeping. These symptoms usually go away, but it can take days or weeks. Sanacora says a psychiatrist may know more about how to help you deal with the side effects while you get used to the medicine.
You want a second opinion. Whether your doctor knows a lot about depression treatment or not, it’s always OK to get help from someone else.
"If you have a feeling in your gut that things aren’t going well -- maybe you’ve tried some things and they’re not working -- it doesn’t hurt to see if you can see a child psychiatrist or psychiatrist," Drozdowicz says.
What Not to Do
If you’re on an antidepressant, don’t suddenly quit taking it. You could have withdrawal symptoms such as nausea, anxiety, vertigo, or brain "zaps." Your doctor might call this discontinuation syndrome.
Always talk to your doctor before you make any changes to your medication. You’ll need to slowly lower the dose over time. They’ll let you know how to do that safely.