Clinicians should be familiar with these interactions and aware of all the medications being taken by their depressed patients. Sleep problems may develop or intensify because of the activation effect of SSRIs. Trazodone is often used as a nonhabituating sedative to enhance sleep. Some patients cease to respond after months or years of SSRI therapy. Change of drug or psychiatric referral is indicated in these patients.
Acute depression necessitates months of drug treatment.
Patient education and supportive, empathic communication are vital to effective treatment. For physicians and patients alike, the appropriate message is, Depression is an illness, not a weakness. The availability of a psychiatrist, patient acceptance, and insurance coverage are additional factors that must be considered in the decision to refer. Common reasons for psychiatric referral include lack of response to acute treatment, suicide risk, recurrence of symptoms during maintenance treatment, development of new co-morbid condition, patient's desire to discontinue maintenance treatment, and pregnancy or the desire to become pregnant. Whether a referral is for consultation or ongoing care, the primary care physician should expect good communication from the psychiatrist.