Depression management lags, but PCPs may hold the key

In January, the U.S. Preventive Services Task Force (USPSTF) modified its prior guidance, recommending that primary care physicians screen adults for depression only if the capacity exists to diagnose, treat and follow up with patients.

The most frequent primary care intervention for depression is use of pharmacology, specifically a selective serotonin reuptake inhibitor (SSRI), according to Rodger S. Kessler, PhD, research associate professor, department of family medicine at the University of Vermont College of Medicine.  

 

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“But there are at least four trials in the last 10 years that suggest that, unless the patient is moderately or severely depressed, the use of an SSRI was no better than placebo,” Kessler says. “So the most common treatment given to the largest number of patients who are screened as depressed is an ineffective intervention. Despite the Task Force’s recommendations, the resources are not there.”

Primary care physicians commonly screen their patients for depression, but still underuse established and effective care management practices compared to other chronic illnesses like diabetes, asthma, and congestive heart failure, according to a recent study published in Health Affairs.

According to study author Tara Bishop, MD, MPH, associate professor of medicine and healthcare policy and research, Weill Cornell Medical College, over half of the eight million ambulatory care visits a year for depression are made to primary care physicians.  

People come to their doctors for depression because they may not have access to psychiatrists or psychologists, their psychiatrists don’t take insurance, or patients feel stigma in seeking mental health treatment.

 

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When they assessed depression treatment at 802 U.S. primary care practices, researchers found that larger practices used an average of only one of five disease management practices (disease registries, nurse care managers, feedback of quality data to physicians, patient reminders and patient education coordinators) and smaller practices even fewer.   

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