The treatment of mood disorders is not as simple as finding a diagnosis and writing out a prescription. Each individual has different causes of depression, and medications used to treat it are just as diverse. Individual characteristics, co-existing illnesses, and tolerance to medications are a few of the characteristics that need to be considered in treating depression.
Bipolar disorder is particularly easy to misdiagnose as patients may fall between bipolar and depression criteria. Symptoms of mania may be overlooked because the depression is so severe (especially when the patient seeks treatment for depression). Bipolar disorder can also be misdiagnosed as another illness.
There are no blood tests or CAT scans one can take to make a definitive mental health diagnosis. Doctors must rely on symptoms and the patient’s history. Treatment involves a combination of patience, knowledge, judgment, and a willingness to try new things.
Family physicians do not specialize in mental health treatment. Some people are seeking initial treatment through their family physician, however, the family physician treats and screens a wide range of illnesses. One study showed that 74% of people seeking help for depression went to their family physician; of this 74%, as many as 50% were misdiagnosed.
The National Depressive and Manic-Depressive Association (DMDA) interviewed 1,000 people with major depression and 881 primary care physicians (PCPs) who were members of the American Medical Association and the American Osteopathic Association.
The DMDA study found:
- Less than 1/4 of patients reported their depression as fully controlled, although they had been taking the same antidepressants for 3 to 5 years.
- 6 in 7 patients reported antidepressants having a positive effect on their lives, but 76% reported sleeping side effects and 59% sexual side effects. Only 17% reported their doctor as having warned them of these side effects, while 47-69% of physicians said they did warn the patient of potential side effects.
- Patients who had problems with side effects were as likely to stop the medication (55%) as to ask for a switch to another antidepressant (57%).
- 40% percent of patients believed they had no choice but to tolerate antidepressant side effects, vs 9% of physicians who believed that.
Physician John Zajecka, MD, associate professor of psychiatry, Rush-St. Luke’s-Presbyterian Medical Center, Chicago attributes the discrepancy to the physician assuming the patient has heard the whole story, when they are really only absorbing 10 to 20% of it.
Dr. Zajecka said that PCPs may complain that it is nearly impossible to schedule a referral because the psychiatrist is booked up. It’s important to understand that psychiatrists are as busy as a family care physicians in the amount of traffic coming in and out of the office. There may be a wait of a week or longer, but a psychiatrist is the best treatment available for mental health care.
Psychologists, who specialize in therapy, are also qualified to treat depression but they cannot prescribe medication. If you are unsure if you should seek a psychiatrist or therapist; you can schedule your first visit with a therapist and see if they refer you to our psychiatrist or not.
Apex’s phone number is (734) 729-3133. Don’t hesitate to call, we are here to help you!