Posted by Cam W. on April 18, 2001, at 1:04:47
In reply to Re: Psychiatrist or GP for treatment of depression??, posted by stjames on April 17, 2001, at 14:59:51
James - Actually, it may not make a difference if one sees a pdoc or a GP for depression. In this month's (vol.58 April, 2001, p.395-401) Archives of General Psychiatry there is an article entitled "Treatment Process and Outcomes for Managed Care Patients Receiving New Andepressant Prescriptions From Psychiatrists and Primary Care Physicians" by Gregory E. Simon, et al (incl. Carolyn Rutter) from the University of Washington.
Although their sample size is small: patients from psychaitrists (n=165) and from primary car physicians (n=204), they found that clinical differences between patients treated by psychiatrists and primary care phsycians were modest. The real only differences (which were slight) were that in primary care there was more incidence of inadequate follow-up visits and inadequate antidepressant treatment. It seems that, contrary to popular belief, psychiatrists too fail to actively follow-up those with depression and shifting the patient to a specialist does not guarantee that inadequate antidepressant dosing will be addressed.
It is easy for me to say, but I believe that patients do need to take a more active role in learning about their disorders and make sure that they are getting adequate treatment no matter who they are seeing. Docs need to take a more active role in teaching the person about their disease state (concordance) rather than just handing out a prescription and expecting the patient to take it (compliance). This is a two way street, though. The patient needs to be forthcoming and honest about their desires for treatment options and tell the doc when they are not taking their meds or are self-medicating with either licit or elicit drugs. The dialogue between the patient and doc needs to be open and frank, with both parties arriving at the treatment option deemed best by both. This should be done regardless of whether the doc is a pdoc or a GP. I really don't think it matters which profession treats depression, if this relationship is in place.
I know I'm being idealistic, but hey that's me - Cam
poster:Cam W.
thread:60176
URL: http://www.dr-bob.org/babble/20010417/msgs/60275.html