Treating depression: Tips for primary care physicians

Primary care physicians are on the front lines of treating patients with depression. In fact, more than half of the care visits for depression in the U.S. are conducted in primary care doctors’ offices, according to a recent Health Affairs study.

The study also found that primary care doctors are more likely to follow established best practice protocols when treating chronic diseases like diabetes and hypertension than they are for depression. That’s likely because many primary care physicians face challenges when treating depression such as limited time during appointments and inadequate access to resources, the study’s authors noted.

That’s in part because successful treatments for depression can be more elusive than for other chronic diseases, says Tara Bishop, MD, the study’s lead author. “We can prescribe antidepressants, but there are other forms of treatment that might be very effective but are difficult to deliver in the primary care setting,” she says.

Below are recommendations from Dr. Bishop and other physicians for adjusting depression treatment protocols to better serve patients.

1. Measurement.

Primary care physicians are more comfortable tracking patients’ progress with chronic physical illnesses, says J. Blake Casher, DO, the medical director of the geriatric psychiatry program at the McLaren-Lansing (Michigan) Hospital. Treatment plans might involve monitoring a patient’s blood pressure or A1C score at each visit.

Depression isn’t as easily quantified, but there are tools that can help, such as the Patient Health Questionnaire (PHQ-9), a brief survey that allows a physician to track a patient’s depression from visit to visit, notes Dr. Bishop.

2. Talk therapy.

In an ideal world, talk therapy in some form would be part of every treatment plan for depression, says Dr. Casher.

“Treatment for depression should not just entail handing somebody a prescription and saying, ‘See you in six weeks,’ ” he says. “Most people do better with a combination of counseling and medication.”

Dr. Casher suggests physicians learn about counseling options available near their practice, noting that psychologists, social workers and master’s-level therapists are all potential options for talk therapy.

3. Using nurse care managers.

Many primary care practices employ nurse care managers to work with patients who have specific chronic diseases such as asthma; they provide patient education, track progress and give feedback to physicians. Primary care practices are less likely to have nurse care managers work with patients who have depression, but they can make a powerful difference, Dr. Bishop says.

If employing a nurse care manager is beyond the reach of a smaller practice, Dr. Bishop suggests investigating other ways to monitor patients, such as creating a registry of patients who have depression. Chronic disease registries can be used to remind clinicians of appropriate interventions and create patient progress reports, according to Medical Economics.

4. Follow up.

Good follow-up practices are critical for patients with depression, says Dr. Casher. Patients don’t always fill their prescriptions or make appointments with counselors, and the extra nudge from the physician’s office can provide the encouragement they need. In addition, some patients are at an increased risk for suicidal thoughts after starting antidepressants, so it’s important to check in with them regularly to make sure that that’s not happening, he says.

Critical work

Although treating depression can be difficult for primary care physicians, effective depression treatment in the primary care setting is crucial because so many patients are only treated for depression by their primary doctor, Dr. Bishop says.

“Depression is really prevalent in this country, and it tends to be very undertreated,” she says. “Also, depressed patients do poorer in terms of their health than patients who don’t have it, so it also impacts their medical conditions.”