Can Primary Care Doctors Treat Depression?

Years ago, if someone thought about mental health care, he or she might have imagined a pipe-smoking psychiatrist listening to a reclining depressed patient from his leather armchair. Today, Depression is more likely to be treated by a primary care doctor who might not have time to sit down at all.

Identifying and treating depression is challenging in a busy primary care office, where waiting rooms might be filled to capacity every day. And there are concerns that depressed patients treated by primary care doctors, unlike those seen by mental health professionals, do not receive needed psychotherapy and close monitoring of their use of antidepressant medications.

But some experts say that the primary care setting has the potential to help people find long-term relief from depression.

Why Depression Is a Primary Care Problem

One reason researchers are interested in improving mental health care in primary care is that, currently, most men and women with depression are not getting the treatment that they need. Results of a national survey on major depression that was published in 2003 in the Journal of the American Medical Association showed that only about half of people with major depressive disorder received treatment.

Before patients can get treatment, someone has to recognize that they are depressed-and that job usually falls to the primary care provider.

"Most people don't see a mental health professional even if they have major depression or anxiety, so the primary care doctor is often the only point of contact," says Donna McAlpine, PhD, an assistant professor at the division of health services research and policy at the School of Public Health at the University of Minnesota. "We want to make sure more primary care doctors recognize depression and anxiety in their patients."

Research suggests that once Depression is identified, most people stick with their primary care doctor for treatment.

"People are comfortable with their primary care doctors," says Kenneth B. Wells, MD, MPH, center director at the University of California, Los Angeles Neuropsychiatric Institute and Hospital. "We're all creatures of habit, and there's still a stigma attached to getting mental health care."

Additionally, Dr. Wells says, psychotherapy with a mental health professional is rarely covered appropriately by insurance. And even if people do have adequate insurance coverage for mental health services-and they obtain a referral to a mental health professional-they end up not following up on the referral unless a primary care office nurse follows up with them. Moreover, in some parts of the country, mental health professionals are hard to find.

Is It Good Enough?