Depressed patients need more than drugs and psychiatrists

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7384.338 (Published 08 February 2003) Cite this as: BMJ 2003;326:338
  1. Sharon J Williams (envisage{at}sympatico.ca), retired psychiatric nurse
  1. 912–1333 Bloor Street East, Mississauga, ON, Canada L4Y 3T6

    EDITOR—Rost et al conducted a randomised controlled trial of ongoing treatment of depression in primary care, and Stroebele in response argued that it would make more sense for a patient to see a psychiatrist once and receive drug treatment if necessary for three or six months. 1 2

    I do not believe a psychiatrist can make an accurate diagnosis after a single visit. Patients do not start to reveal themselves until a genuine trust and rapport have been established. Information gathered on an initial visit is likely to be extremely superficial and inadequate simply because the patients are depressed. They are not thinking clearly and usually forget to tell their doctors the most important things the doctors need to know.

    I have seen too many misdiagnoses and bad prescribing of drug treatments. The pharmaceutical monographs available on drugs are often based on human trials in healthy male participants who are taking no other drugs. Therefore when a new drug enters the market, all its possible interactions, adverse effects, and contraindications have not yet surfaced. Doctors are poor at reporting adverse effects, so they are often never published. Unexpected paradoxical reactions can kill people or make them wish they were dead. This has happened to people I know who were being treated for depression.

    It can be difficult to find the correct drug and dosage the first time. People taking any kind of drug, particularly psychoactive drugs, need to be monitored closely and questioned carefully and regularly until the effectiveness of the drug is determined and any adverse side effects have been evaluated.

    Finally, many people cannot call on active networks for support, and family doctors have neither the time nor the training to help a person cope with depression.


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