Key points
Getting a depression diagnosis with little explanation, reassurance, or monitoring can lead to poor results.
Integrative treatment addressing emotional, cognitive, physical, and spiritual symptoms is too rare.
Psychoeducation isn't optional. Being provided with a roadmap for recovery is essential.
Developing a constructive collaborative relationship with your doctor is key to a good outcome.
There are many signs of depression and they often manifest in different ways physically, emotionally, and cognitively. Medication for biological depression is ideally targeted to specific symptoms. Some medications focus more on mood, others on thinking processes, others on sleep issues, etc. But, even when medication is called for, it is never the sole solution to achieving the optimal outcome.
Many people make the mistake of assuming an "either/or" attitude: "I will either take an antidepressant or practice Tai Chi or go into therapy to cure my depression." Ultimately, though, an integrative approach may be most effective. You may want to start psychotherapy and see how it goes before considering medication. Incorporating breathing techniques that increase mindfulness into your daily life can be helpful in regulating mood. Eating well and exercising regularly support a positive mindset. The key is to address the whole you.
Lack of Access to Specialized Care
One of the challenges to getting good treatment for depression is that many people who suffer from it are not being treated by practitioners who specialize in the condition. Unlike other medical conditions, like cancer, heart, and kidney disease, depression is often not treated by specialists in the field. According to one study from 2016-2019, more than 60 percvnt of psychiatric medications were prescribed by general practitioners, nurse practitioners, and physician assistants, not psychiatric specialists. Research published in Health Affairs found that a significant percentage of primary-care doctors reported feeling less equipped to handle mental health problems than conditions such as asthma and high blood pressure. While for some patients, a quick prescription for Prozac, Zoloft, or another antidepressant may be effective, for others it will take trial and error and close monitoring to land on the right combination of drugs. This type of strategic, symptom-specific prescribing of psychiatric medication, with frequent follow-up, is not something typically provided by a primary-care doctor.
Time for Patients is in Short Supply
The time patients spend with doctors in America is in short supply, which is another factor that can prevent a successful treatment outcome. Today most primary care physicians work in large clinics run by corporate entities. Many are pressured to see a high volume of patients in an insufficient amount of time to conduct a comprehensive consultation. In many cases, diagnoses are made based on forms a patient fills out rather than an in-depth interview. Disorders of thoughts, emotions, impulsivity, obsessions and compulsions, memory, attention, and judgment may only be apparent when a doctor has the chance to observe how a patient talks, looks, and acts.
The importance of having a good consultation cannot be overstated. People who are depressed are almost always anxious about their condition. Receiving a quick diagnosis with little explanation, preparation for treatment, or reassurance can lead to disappointing results. A patient may stop taking their medication if it doesn’t work as quickly as they anticipated or if they experience an unexpected side effect and have received no guidance about how to handle it. An inadequate consultation can lead to a failed outcome, which leads to even more hopelessness.
More than 2500 years ago, Hippocrates, the father of medicine, is believed to have said, “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” Ideally, by the time your consultation is over, you, as a patient, feel known. You feel confident that your doctor understands your physical, emotional, and biological/genetic situation. You sense that you can have a constructive collaborative relationship with your doctor. You’ve been presented with a meaningful diagnosis and better understand the condition from which you’ve been suffering. You have been prepared for what the treatment process will look like You’ve been given reassurance that your future will be brighter.
In our view, psychoeducation is not an optional deliverable. You wouldn’t embark on a road trip to a new destination without using your GPS or looking at a map, so why should you be expected to go on the journey to recovery without some educational navigation assistance? Without understanding the how, what, when, where, and why of depression and recovery from it, people are often overwhelmed with anxiety and confusion, stop taking medication before it becomes effective, and sabotage a successful outcome without realizing it.
If you or a loved one are experiencing signs of depression, seeking treatment from a professional is a must. If you find that your mental health consultation leaves you feeling confused about your condition, the recommended treatment, and what the recovery process will look like—or if you feel a lack of connection with your practitioner—seek a second opinion. Ultimately, being provided with preparation, reassurance, and hope as you begin your journey to recovery can make all the difference in whether or not treatment is successful.
Note: This article originally appeared on Psychology Today. To find a therapist, visit the One Life Psychiatry.
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