Care for Your Mind
For most people, Primary Care Providers are their most accessible health care professionals. PCPs (for example, general medicine or family physician, nurse practitioner) are the first line of care for a host of physical conditions and are frequently the first to diagnose and treat depression. Because PCPs are busy and not always attuned to mental health issues – especially as mental health disorders are often masked by physical complaints and discussion of concerns is stymied by stigma – it’s important for caregivers of people living with mood disorders to be educated about depression and prepared to advocate for the treatment that best fits their loved ones’ goals, preferences, and priorities.
Know the range of depression symptoms
A person with major depressive disorder may be experiencing a variety of symptoms and, with medication treatment, some side effects as well. Though people are generally familiar with down mood or hopelessness as being signs of depression, they may not know about depression’s impact on sex drive or executive functioning.
Depression symptoms commonly include issues such as down or depressed mood; sense of hopelessness; social withdrawal and isolation; loss of interest or pleasure in people and activities previously enjoyed; being irritable or angry; changes in sleep patterns or eating habits; slowed speech or movement; unexplained aches and pains; abusing alcohol or drugs; or having thoughts of death or suicide. In addition to those, there are thinking-related issues that affect functions like reasoning, organization, attention, and memory (which we refer to as “ROAM” symptoms).
Regardless of the particular symptoms or side effects affecting your loved one, support them in having conversations with their health care provider about these issues to better inform development of the personalized treatment regimen that fits them best.
Know your loved one’s wellness goals
As we have discussed in this series, every treatment should support your loved one’s idea of “being well.” Selecting the treatment should be a collaborative process among the health care provider, the person living with depression, and you (as applicable) to identify and achieve your loved one’s own defined wellness goals. At a minimum, treatment should be designed to resolve symptoms and recover the ability to function. Talk with your loved one about their goals, priorities, and preferences.
- What does wellness look like for them?
- What are your loved one’s preferences and priorities in treatment and outcomes?
- Which symptoms are most important to resolve for day-to-day functioning?
- How can you support your loved one to be an active participant in their own care?
Be an advocate
People with depression are often not strong advocates for their own care. Feelings of worthlessness
and disorganized thoughts often interfere with self-advocacy. By voicing or reinforcing your loved one’s preferences and priorities to the provider, you can help them get the best treatment available that fits their needs.
Aim to have depression fully treated
The optimal goal of depression treatment is “full symptomatic remission and recovery of function,” according to Dr. Bradley Gaynes et al., while barriers to achieving remission and recovery include inadequate response to treatment, inability to treat all symptoms, and adverse effects of antidepressant medications as barriers to achieving remission and recovery. We also know, as Dr. Anita Clayton commented recently here on Care for Your Mind, that initial medication success rates are not great: overall, only about 50% of people respond to the first medication and only about 30% achieve remission with their first line of medication treatment.
Medication is an important part of treatment for most people experiencing moderate to severe depression. Psychotherapy can be an important component of depression treatment by, for example, helping to change negative patterns of thinking and address past experiences. People with depression also benefit from practical self-care, including getting adequate sleep, eating well, and engaging in frequent physical exercise. Each element of the treatment plan should be tailored for the individual to increase their likelihood of achieving remission and recovery.
As many clinicians, people living with depression, family members, and co-workers can attest, cognitive impacts of depression can persist after other depression symptoms have resolved. (See, e.g., M. Kaser et al., Cognition as a Treatment Target in Depression and the research cited therein.) Addressing depression’s cognitive impacts may require, for example, adjusted expectations (at least in the short term), use of a different medication, utilizing strategies that prompt better executive functioning, and accommodations at work.
Help track symptoms
People with depression often have trouble remembering the depth and duration of their symptoms and don’t always have an accurate perception of their level of functioning. Having a record of symptoms, activities, and treatment adherence (e.g., taking medication regularly as prescribed, following a sleep schedule) supports better clinical care because accurate data allows the health care provider to develop a sense of whether or how well the treatment is working.
It may not be clear whether cognitive symptoms are a side effect of medication, a result of depression, a combination of both, or some other cause altogether. You can help the provider
by noting when symptoms began; whether they have gotten better, worse, or stayed the same; and whether any strategies are effective in supporting better functioning. Work with your loved one to use the ROAM Symptom Tracking Chart to record problematic symptoms that they are experiencing. They should bring the completed sheet to the clinician and review these concerns.
Work toward wellness
The provider should be looking beyond mood to your loved one’s overall wellbeing and functioning. As we have learned throughout this series, one of the most important factors for recovery is continued communication with one’s health care provider and advocacy for personalized, tailored treatment.
What do you think?
What have you found useful in supporting a loved one with depression to get tailored care?
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On Care for Your Mind (Depression Treatment series)
- Depression Treatment: It’s About You
- What You Know Affects Treatment
- Response, Remission, Recovery: What Are Your Depression Treatment Goals?
- Why You Deserve Shared Decision Making
- Shared Decision Making – with Families – Yields Better Outcomes
- How to Get the Best, Most Appropriate, Tailored for You Depression Treatment
- How to Address Other Issues in Depression Treatment
- Faster and Easier Approaches for Improving Patients’ Depression Treatment Outcomes
- Ways to Facilitate Depression Treatment
- When Primary Care Providers Treat Depression – Tips for Engagement
- How to Help a Loved One with a Mood Disorder: The FFDA Action Plan
- Does Your Family Know Your Mental Health Care Preferences?
Depression Treatment in Primary Care
- Caregiver Resources from Families for Depression Awareness
- deGruy, F., Treatment of Depression in Primary Care
- Tufts Health Plan, Clinical Guideline for the Treatment of Depression in the Primary Care Setting (download)
- Consultant 360, Major Depression: Treatment in Primary Care
- ICSI Guidelines, Depression, Adult in Primary Care
- G. Mattingly et al., The impact of cognitive challenges in major depression: the role of the primary care physician