Newsgroups: sci.med
Subject: Re: Depression; was: Re: Thyroid info needed
From: RGINZBERG@eagle.wesleyan.edu (Ruth Ginzberg)
Date: 24 Jan 93 12:23:13 EDT
Distribution: world
Organization: Philosophy Dept., Wesleyan University
X-News-Reader: VMS NEWS 1.20In-Reply-To: rind@enterprise.bih.harvard.edu's message of 24 Jan 93 04:11:09 GMTLines: 47

In <2445@hsdndev.UUCP> rind@enterprise.bih.harvard.edu writes:
> 
> Certainly it makes sense to look for physiologic problems causing 
> fatigue, but in a primary care setting it will be rare to find any.
> The point I was making was that rather than saying "it's depression"
> too quickly, the evidence suggests that primary care physicians
> are in fact far too slow to make this diagnosis.

Gee---

Are you sure this is still true, even now, with the so-called 3rd generation
antidepressants available?  My understanding is that Prozac is now one of the
10 most frequently prescribed drugs in the USA, & if you add that to Zoloft &
Wellbutrin I bet ... well, I'd be surprised if all these prescriptions were
coming from psychiatrists.  It would be interesting to know (maybe someone does
have figures??) what %age of (e.g. Prozac or Zoloft) prescriptions come from
psychiatrists & what percentage come from primary care physicians, & then to
compare that against (e.g., Elavil or whatever was popular pre-Prozac).  I
wonder if this ratio has changed since the advent of antidepressants without
such obnoxious anticholinergic(sp?) side effects (which I bet most primary care
physicians would just as soon leave to the psychiatrists to deal with).

IMHO -- up until the last 6 years or so, medicine really didn't HAVE very good
pharmacological treatment available for mild-moderate depression.  The side
effects of the tri-cyclics & the MAOI's were so unpleasant to many patients
that many of them preferred to tolerate mild-moderate depression rather than
putting up with the side effects of the medication.  It was only if the
depression became more severe that the disease actually seemed worse than the
meds.  & for a more severe d3epression, the primary care physician WOULD
(appropriately) refer pt to psychiatrist for eval & treatment.  So (again,
IMHO) I would think that -- in the past -- primary care physicians might have
been reluctant to diagnose mild/moderate depression, exactly BECAUSE that meant
facing a pretty abysmal array of treatment options, & who wants to say to a
patient "Well, it looks to me like you're moderately depressed, but to be
totally honest, there's not a whole helluva lot I can do for you for that.  I'm
sorry that you feel lousy.  Want a referral to a psychotherapist so that you
can talk about it?"  It SURE seems a lot more appealing to be able to say,
"Well, it looks to me like you're moderately depressed, & you're in luck; 
there are several new medications which should be able to start helping you to
feel better within a week or so, most likely without serious side effects." 
Don't y9ou think this might change the reluctance to diagnose depression on the
part of primary care physicians?


------------------------
Ruth Ginzberg <rginzberg@eagle.wesleyan.edu>
Philosophy Department;Wesleyan University;USA
Newsgroups: sci.med.nutrition