Mental Health Services Often Start With Primary Care
Most psychiatric care starts with a primary care provider, even if a patient eventually winds up seeing a mental health professional. This is because many primary care providers screen their patients for depression during their annual visit, as recommended by the U.S. Preventive Services Task Force .
A simple two-question inquiry is often the starting point. Your primary care provider asks you how often, over the last two weeks, you have had little interest or pleasure in doing things or were feeling down, depressed or hopeless.
If your responses indicates depression is likely, and then you will be asked a few more questions. Depending on your responses and symptoms, your primary care provider may prescribe antidepressants, give you a referral for psychotherapy services, or both.
Why Do Some People Get Depressed When They Have Covid
Scientists are still learning exactly how the coronavirus alters the brain, but research is beginning to highlight some possible explanations. A few studies, for example, have shown that the immune system goes into overdrive when some people get sick. They can end up with inflammation throughout the body and even in the brain. There is also some evidence that the endothelial cells lining blood vessels in the brain become disrupted during a bout of Covid-19, which may inadvertently allow harmful substances through, affecting mental function. And cells called microglia, which normally act as the brains housekeepers, may go rogue in some patients, attacking neurons and damaging synapses, Dr. Al-Aly said.
Its possible that Covid-19 may even compromise the diversity of bacteria and microbes in the gut. Since microbes in the gut have been shown to produce neurotransmitters like serotonin and dopamine, which regulate mood, this change could be at the root of some neuropsychiatric issues.
Lifestyle Changes For Depression
Lifestyle changes, such as making art, journaling, exercising more, and practicing yoga or mindfulness, can also alleviate depression and the stress that can heighten it. Alternative treatments like massage, acupuncture, and light therapy may also help.
Diet changes, too, can uplift your mood by reducing inflammation and helping to ensure your brain gets the nutrients it needs to function at its best.
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How Do Antidepressant Drugs Work
In the brain, electrical signals speed messages from nerve cell to nerve cell but are relayed bychemical signals across the tiny gap between nerve cells. Antidepressant drugs affect those neurotransmitters, such as norepinephrine, serotonin, dopamine and others belonging to a class of chemicals known as monoamines.
Antidepressant medications such as the SSRI’s can increase or decrease neurotransmitters, act as substitute neurotransmitters, or regulate the receptors that the neurochemicals bind to. While those changes may contribute to the effects of antidepressant agents, they are not considered the main source of improvement. The reason is that those changes happen immediately, but the drugs can take six weeks or more to provide relief of symptoms. Researchers believe that the time lag is due to the development of new nerve cell connectionsneuroplasticitywhich pave the way for mental and behavioral flexibility.
Studies show that 40 to 60 percent of patients treated with an antidepressant experience an improvement in symptoms within six to eight weeks. Care standards specify that once remission is achieved, treatment should be continued for four to nine months.
When Do Covid Blues Become Clinical Depression What Are Some Early Signs
While you are in the thick of things, fighting off viral infection, it is normal to feel tired and headachy. When you feel physiologically terrible, it can interfere with your mood, Dr. Hosey said. I would never diagnose somebody with a clinical depression in the acute phases of a Covid infection.
But if your exhaustion and feeling of being overwhelmed persist for two to six weeks after your Covid infection and start to interfere with day-to-day activities or negatively affect your relationships with others, it could be a sign of depression, Dr. Hosey said.
Some people with depression may also experience persistent sadness, tearfulness, irritability, changes in appetite or weight, trouble thinking or concentrating, or feelings of immense guilt, worthlessness or hopelessness. Those with severe depression may think frequently of death and develop suicidal ideation, Dr. Hosey said.
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Side Effects Of Antidepressant Medications
All medications can have side-effects. Some people experience no side-effects. Others may find the side-effects distressing. In most cases, side-effects lessen as treatment continues.
Treatment is usually started at a low dose, to minimize side-effects, and then slowly increased until the ideal dose is found. The ideal dose is one that provides the greatest benefit with minimum side-effects.
If you are experiencing side effects, check the information given to you by your doctor or pharmacist on the specific effects of any drug you have been prescribed. If side-effects are not mild and tolerable, it is best to continue taking your medication as prescribed but let your doctor know as soon as possible. Your doctor may:
- encourage you to wait a little longer for the side-effects to fade
- adjust your dose
- suggest you take the medication at a different time of day
- prescribe other medications to help control side-effects
- change your medication
- stop medication treatment and suggest a different type of treatment approach.
Side-effects vary depending on the type of medication. More information on side-effects is included for each type of types of antidepressant.
You can help to control possible side-effects on your own by:
Do antidepressants increase the risk of suicide?
Before starting treatment, prepare for the possibility of feeling worse before you feel better. Know what supports are available to you and who you can call.
What Are The Complications Of Depression
When depression becomes very severe, dark thoughts can emerge and these can even lead to suicide. If you are having thoughts of suicide, talking to someone you trust can help.
If someone you care about has severe depression, learn the warning signs, since they may be feeling so bad that they cant see their way out alone.
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Your Primary Care Provider Can Help Treat Your Mental Health Too
When you think of receiving mental health services, you might think this means an appointment with a counselor, clinical psychologist or psychiatrist. But did you know that primary care providers, such as family doctors and internists, can play an important role in providing mental health services too?
They can and they do: Family physicians are one of the primary sources for mental health care in the United States, says the American Academy of Family Physicians .
Primary care physicians are the primary managers of psychiatric disorders in one-third of their patients, the AAFP reports. And two-thirds of patients with depression receive treatment for their depression in the primary care setting, the AAFP says.
Adults made an annual average of 30 million mental health-related physician office visits between 2012 and 2014, according to data published in 2018 by the U.S. Centers for Disease Control and Prevention. While psychiatrists provided care for 55 percent of these visits, primary care physicians provided care for 32 percent.
So you dont have to wait for an appointment with a psychiatrist if you feel the need for mental health care services. You can bring up any concerns about your mental or emotional health with your primary care provider.
This has become even more important in the COVID-19 pandemic era, as many lives have been upended due to working from home, remote classes, joblessness, grief and isolation.
How Urgently Are You Wanting Or Needing To Start Treatment
If you need to start treatment right away, your best choice will most likely be your PCP. This is true even if your answers to the other questions in this guide suggest that a psychiatrist might be a better choice.
Even though primary care practices can also have waiting lists, the wait times to see a PCP are nearly always shorter than the wait times to see a psychiatrist.
Theres a severe psychiatrist shortage in the United States. It can take several months to get an appointment with oneif theyre even taking new patients at all. Its worth checking whether a local psychiatrist has an opening, but in most cases, youll see a PCP a lot faster than youll get in to see a psychiatrist.
We think it’s much better to get started with a PCPeven if they ultimately refer you to a psychiatristthan to wait to get help until you’re in crisis.
If youre already in crisis, dont wait for an appointment with a psychiatrist or a PCPreach out for help immediately. By calling a national hotline or a local crisis line, you can connect with caring professionals wholl help you get the care you need right away.
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When Is Ketamine Used
Ketamine, long used as an anesthetic, is now used against treatment-resistant depression in controlled circumstances. Infused intravenously in carefully titrated doses over a period of hours, it is very fast-acting, relieving symptoms within hours, with the effects of a single infusion lasting for days or a few weeks, in about 50 percent of patients. It is especially useful for helping patients troubled by suicidal ideation and is widely used in emergency psychiatry. A variant form of ketamine, esketamine, is delivered by nasal spray.
Ketamine works by blocking a non-monoamine neurotransmitter, glutamate, which influences the activity of all other neurotransmitters. It can have side effects, such as producing dissociation and hypertension, that, along with its short-lived effect, limit its use.
How Can I Help A Loved One Who Is Depressed
If someone you know has depression, help them see a health care provider or mental health professional. You also can:
- Offer support, understanding, patience, and encouragement.
- Invite them out for walks, outings, and other activities.
- Help them stick to their treatment plan, such as setting reminders to take prescribed medications.
- Make sure they have transportation to therapy appointments.
- Remind them that, with time and treatment, the depression will lift.
Take comments about suicide seriously, and report them to your loved ones health care provider or therapist. If they are in immediate distress or thinking about hurting themselves, call 911 for emergency services or go to the nearest hospital emergency room.
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How Depression Is Diagnosed
If you plan to see your doctor about depression, here are a few tests your doctor could prescribe.
Physical examination
Your doctor may do a physical exam and ask you health-related questions. Depression may be connected to an underlying physical health condition in some situations. Your doctor may attend mainly on the brain and endocrine systems during the physical exam.
The doctor will investigate any serious health issues that may be contributing to the depression symptoms.
Lab tests
Your doctor may request lab testing to rule out other diagnoses. Your doctor will most likely order blood tests to rule out any medical problems that might be causing your symptoms.
Blood tests will be used to screen for anemia, thyroid, or perhaps other hormones, and occasionally calcium and vitamin D levels. For instance, your doctor may perform a blood count or examine your thyroid to ensure it is working correctly.
Psychiatric examination
Your mental health professional will inquire about your symptoms, thoughts, feelings, and patterns of behavior. To help you answer these questions, you might be asked to fill out a questionnaire.
It is critical to remember that the assessments and questionnaires used by the doctor are only one element of the diagnostic process of determining depression. On the other hand, these tests can occasionally provide your doctor with more information about your mood. They can use them to establish a more definite diagnosis.
DSM-5
How Can I Get Antidepressants
Though there are numerous antidepressants, one common feature is the need for a prescription. This requirement may seem like a barrier, but since there are very few limits and regulations for antidepressants, they are still easy to obtain.
The most straightforward way to get antidepressants is to schedule a visit with your primary care physician or mental health prescriber. During the appointment, let them know:
- What symptoms you are experiencing
- The presentation and impact of the symptoms
- That youre willing to take a medication
With this information, your prescriber will determine if they believe an antidepressant is right for you and which one would be best. There are different types of antidepressants with the most common being:4
- Serotonin and norepinephrine reuptake inhibitors
- Atypical antidepressants )
SSRIs are the most commonly prescribed option, but your symptoms and history may indicate that another choice would be more helpful for you. A person should always honestly discuss their history, side effects, and previous medication trials with their prescriber to find the best medication to fit their individual needs. It is important to note that antidepressants usually take 4-6 weeks to show their full effects so it is important to be patient and continue to check in with your healthcare provider about any side effects or worsening or unresolved symptoms.
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What Are The Different Types Of Depression
Two common forms of depression are:
- Major depression, which includes symptoms of depression most of the time for at least 2 weeks that typically interfere with ones ability to work, sleep, study, and eat.
- Persistent depressive disorder , which often includes less severe symptoms of depression that last much longer, typically for at least 2 years.
Other forms of depression include:
- Perinatal depression, which occurs when a woman experiences major depression during pregnancy or after delivery .
- Seasonal affective disorder, which comes and goes with the seasons, typically starting in late fall and early winter and going away during spring and summer.
- Depression with symptoms of psychosis, which is a severe form of depression where a person experiences psychosis symptoms, such as delusions or hallucinations .
Individuals diagnosed with bipolar disorder also experience depression.
Why A Mental Health Professional Is Best
It’s very importantespecially if this is your first time seeking treatment for depressionthat you obtain a referral to a psychiatrist or other mental health professional if your general practitioner suspects depression.
Though your family doctor or general practitioner may offer to prescribe you an antidepressant, they are not always the best-qualified doctor to treat depression. They do not possess the training to offer you psychotherapy nor are they experienced in the nuances of prescribing psychotropic medications the way that a psychiatrist is.
Psychiatry is a blend of art and science. Treating depression is not quite as simple as giving someone a prescription for Zoloft or Prozac and sending them on their way. Some individuals will need several trials of different medications to find one that best relieves their symptoms with the least amount of side effects.
Some people will need more than one medication to counteract side effects or to boost positive effects. Most will likely benefit from adding psychotherapy to the mix. Discussing options with your psychiatrist will determine the best path.
Depression Discussion Guide
Besides the medication specifics, you may have a completely different mental health condition and not depression. Bipolar disorder is one such disorder that may be initially misdiagnosed as depression but requires a very different course of treatment.
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How To Talk To Doctor About Depression And Anxiety
Use clear statements such as I think I may be depressed or I am having trouble with anxiety. This will help guide them and let them know what direction to go in. Be as open and honest with your doctor as possible. He or she cant help you if they dont know everything that is going on.
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When Are Antidepressants Prescribed
Antidepressants are commonly used to treat depression and anxiety, among other conditions.
The American Psychiatric Association defines depression as a very serious medical illness that negatively affects the way you think, act, as well as how you feel. When left untreated, it can greatly impact your overall quality of life, making it difficult to function or do the things that you used to enjoy.
Depression affects millions of Americans each year. In fact, major depression is one of the most commonly seen mental health conditions in the United States.
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Tms Therapy For Depression
If youre suffering from major depression that has been resistant to therapy, medication, and self-help, then TMS therapy may be an option. Transcranial magnetic stimulation therapy is a noninvasive treatment that directs recurring magnetic energy pulses at the regions of the brain that are involved in mood. These magnetic pulses pass painlessly through the skull and stimulate brain cells which can improve communication between different parts of the brain and ease depression symptoms.
While TMS may be able to improve treatment-resistant depression, that doesnt mean its a cure for depression or that your symptoms wont return. However, it could provide sufficient improvements in your energy and drive to enable you to begin talk therapy or make the lifestyle changessuch as improving your diet, exercising, and building your support networkthat can help preserve your depression recovery in the long term.
Appointment With Medical Doctor
The first step involves setting up an appointment with either a doctor or psychiatrist. Most people who have major depression prefer working with a psychiatrist as opposed to a general practitioner. Although a general practitioner can prescribe antidepressants with good intentions, they lack the specific knowledge that a psychiatrist should have about antidepressants.
- Psychiatrist: Recommended
- General practitioner: Not recommended
If you are unable to get into a psychiatrist, you can certainly seek the help of a general practitioner. The only major difference between the two is that a psychiatrist may have a better understanding of your specific depressive subtype as well as other comorbid diagnoses. Therefore a competent psychiatrist will understand what medication will best suit your specific situation.
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