Treating Depression in Primary Care

By Roxanne Karter

A wellness visit is an opportunity for your primary care provider to examine your health at regular intervals. In addition to the stethoscope, blood pressure gauge and tongue depressor, our ears are one of the most important tools we bring into the exam room. Because oftentimes what we hear from you, the patient, about how you’re feeling is as telling as any medical test.

When we see a patient with a chronic complaint, like pain or fatigue, and can’t find any physical reason for an ailment, mood disorders become part of the discussion. It may be surprising to some to learn that depression is frequently first diagnosed by a medical provider, who then works together with a mental health professional to provide treatment.

A diagnosis of depression might begin with a couple simple questions: are you losing interest in everyday activities? Do you find yourself withdrawing from life? If the patient expresses concern about depression, we have a tool called the PHQ-9, a patient health questionnaire consisting of nine items that helps us evaluate whether he or she has symptoms of depression and how serious it might be. The PHQ-9 becomes really valuable as treatment progresses, since it can help show someone how they’ve improved over a period of months.

While your primary provider would most likely refer you to a mental health counselor, he or she would more than likely be in charge of prescribing any medications. Most mental health therapists don’t have the medical background to prescribe drugs, and a psychiatrist (who can prescribe medications) would most likely not be seeing a patient unless it was a very serious mental illness.

There are a number of medications available to treat depression now that were not available in the past, but they are not for everyone. One of the hard truths about any of these drugs is that they don’t have an immediate effect. While an anti-anxiety drug would help you calm down right away, anti-depressants take several weeks before they might have an impact. It may also take some time to find which drug works best and what the right dose would be for you. There may be side effects like weight gain and decreased libido to consider whenever you take these medications.

Many patients are able to combat depression without taking any drugs. A growing body of research shows exercise is as effective as medication. Aerobic exercise, like walking, improves blood flow and oxygen to the brain. This type of activity also releases endorphins, a chemical in your body that creates a feel-good sensation. People who engage in even moderate exercise recover more quickly from mild depression than people who are inactive.

Several primary care practices in the Brattleboro area are part of Vermont’s Blueprint for Health Initiative. This gives them access to the Community Health Team (CHT) at Brattleboro Memorial Hospital, which has a number of resources to help patients develop and maintain healthier lifestyles. Many of the CHT services are free to patients. Don’t be afraid to talk with your primary care provider about how you’re feeling emotionally as well as physically during your next office visit. You might be happy to learn just how much we can do to help you feel better.

Roxanne Karter, APRN is a board-certified adult nurse practitioner at Brattleboro Internal Medicine, a member of BMH Physician Group. She can be reached by calling 802-257-2611.