• Providers Home
• Administrative Resources
• Practitioner Resources
• Pharmacy Information
• Self-Help Forms
• Confidentiality Information
• Newsletters

Parting Shots About Depression

Forty years of psychiatry have left me with some thoughts about helping patients who suffer from depression. It can be a remarkably debilitating illness. I’ve had patients say that their depression was harder to deal with than their cancer.

1. Patients still greatly value their relationship with their doctor. It is perfectly appropriate to ask about depression. Many patients are relieved to talk and not the least embarrassed by having the chance to finally voice some feelings that they have been having.
2. The fact that the patient cries doesn’t necessarily mean they are suffering from depression, just that they are upset about something. It does mean that we need to explore the issue further.
3. Stigma is still alive and well. There is a lot of shame about getting depressed. People fear it means they aren’t trying hard enough, or they are weak. They, or someone they care about, may not understand/believe the illness concept. Validation is a big part of what we do.
4. I truly dislike the idea of “chemical imbalance.” It is overly simplistic and doesn’t help patients. I use the idea that the brain is the regulatory mechanism for the body, keeping things in balance. When the stressors are too big, or the thermostat doesn’t work right because of bad genes, or trauma, it is hard for the brain to do its regulatory job. Medication can help the brain to restore normal functioning.
5. Exercise, diet, stress management, are all incredibly valuable in managing and preventing depression (good idea for work-too-hard docs as well).

1. Little interest or pleasure in doing things?
2. Feeling down, depressed, or hopeless?

If the patient answers yes to either one of those questions, then it is important to follow up with more questions to confirm the diagnosis of depression. A flow chart for this process can be found on page 2 in the Clinical Practice Guideline.

• Determine if the patient needs therapy, medication, or a combination of both.
• Provide them with contact information if the member is open to therapy.

Tips for prescribing medications

1. Educate the patient about delayed onset of effect
2. Caution them to not stop the medication because they are feeling better – they need to stay on it for at least six months
3. Follow up within one month. Many patients have only a partial response to initial dose of medication. 
4. • If you intend to prescribe an antidepressant for the patient, take the time to educate them. Let them know that it may take some tweaking to get the correct dosage for the member and that they can expect to remain on the medication for at least six months. Encourage them to contact you if they have any questions or concerns about side effects. Selective Serotonin- Reuptake Inhibitors (SSRIs) are known to cause sexual side effects. Be sure to ask the patient directly about this as they may be reluctant to bring this up
   • For young adults ages 18-24, assess during the first two weeks for suicidal ideation. Continue to follow up with the patient every 4-12 weeks until their symptoms are in full remission, at which point you can have them continue on the medication for 6-9 months and see them again at that time.
5. Patient should be symptom free for 6-9 months before considering medication taper or maintenance therapy, depending on their history with depression, risk factors, etc. For maintenance medication, contacts can occur every 3-12 months if everything else is stable. See the Treatment Plan for Depression in Adults – Flow Chart in the guideline for more information.

To access behavioral health services call:

• UW Behavioral Health—800-683-2300 or 608-233-3575
• Mental Health Center of Dane County—608-280-2700 (for BadgerCare+ Members in Dane County.)

* The guidelines may be found at unityhealth.com by clicking Providers, Practitioner Resources, and then Clinical Guidelines.

Back to Newsletters