How to Get the Best, Most Appropriate, Tailored-for-You Depression Treatment

Dr. Anita Clayton on depression treatment on Care for Your Mind

Anita H. Clayton, M.D.
Chair, Department of Psychiatry & Neurobehavioral Sciences
University of Virginia School of Medicine

Depression can negatively impact all aspects of a person’s life, from interpersonal relationships at home and in social circles to productivity at work. Untreated depression can last for a year or longer. There are effective treatments, but for any treatment plan to be successful, it has to be followed. You can learn to advocate for your (or your loved one’s) care to find the personalized treatment plan that aligns with your goals, preferences, and priorities and boosts your likelihood of sticking with it.

We asked Anita Clayton, M.D., to share her insights on how to get the most out of a visit with your clinician when you have depression. Preparation, self-advocacy, and communication with your provider can go a long way in getting you the treatment that fits you best.

As a health care provider, I want to set you up for success. It’s that simple, but to achieve that, I want you to be an active participant in deciding your care. If you have family members who can provide emotional, logistical, decision making, or other support, include them. If you have trouble advocating for yourself and your health care, find someone who will support and assist you and bring them along. The treatment plan should be made with your input and be based on what’s important to you, giving you the best chance of achieving your goals.

The sooner we can get started on treatment, the better. If you are experiencing depression-related symptoms that are affecting your functioning at home, at work, or socially, get help. When you come to the office, be prepared. Know what you want to get out of an appointment before you go in. Write down the specific issues you are experiencing and your questions, and bring your notes to the appointment.

Through my years of psychiatry practice, I’ve found that patients nearly always have an agenda for the appointment, but they often don’t raise their concern with me. If there’s something that’s on your mind, whether it’s sleeping, concentrating, remembering things, libido (sex drive), or another issue, say it. Also, beginning with that first appointment, let’s talk about how we can structure your treatment so that you stay with it. We can’t know if the treatment is effective if you’re not doing it (e.g., taking the medication.)

For most people living with depression, because of the number of medications available for treating depression, it is likely that there is more than one medication that can be considered for a person’s individualized treatment plan. In my practice, we like to offer two medications that act differently, then help the patient get the information they need to make a decision between the two choices. What are the deciding factors? It usually comes down to the medication side effects that you are willing and able to tolerate. Are any side effects exclusionary, so that you won’t consider being on a particular medication?

The most common side effects that I discuss are weight gain and sexual dysfunction, but people also have concerns about being drowsy, not experiencing their feelings (becoming numb) or any treatment that might make it more difficult to think clearly (becoming foggy). It may be surprising, but the issue of sexual dysfunction as a result of medication is not a self-identified concern for one gender more than another.

Nearly three-quarters of people with depression report sexual dysfunction (e.g., reduced interest in sex), but anorgasmia (inability to reach orgasm) is often a consequence of treatment with SSRIs (selective serotonin reuptake inhibitors, which include medications such as sertraline, fluoxetine, citalopram, escitalopram, and others). Every health care provider should know that sexual dysfunction is a likely issue with depression and they should not be reluctant to engage in conversation about it and establish a baseline level, especially because some antidepressants don’t produce sexual side effects.

People often don’t talk to their providers about sex and intimacy because of embarrassment, but maybe not the way you expect. Seventy percent of people think it will be embarrassing for their providers, not themselves! The members of your care team, whether your primary care provider, psychiatrist, or other medical professional should be asking about your sex life not to judge it, but to learn if you are living your life as you would like to be or if something like depression or its treatment is affecting that part of your life.

We might not be successful with the first treatment regimen. Given the statistics, we know there’s a good chance that we’ll need to make an adjustment before we find the right treatment for you. Practically speaking, an initial antidepressant is effective for only 50% of patients. We can improve these odds if information is available about successful treatment of major depressive disorder (MDD) in close family members but if the first medication is ineffective, it is important not to be discouraged or give up. For those who need to try a second drug, we see positive response in about 75% of that group. That’s a pretty good chance – though not a certainty – that we’ll be able to find something that meets your needs and works for you. And if you don’t have a positive response to the third medication, there are non-medication interventions that are available, such as brain stimulation techniques, as well as medications that work well in combination with antidepressants to yield positive results. And if something is working, let’s build on successes and see if we can make it work better.

You may also benefit from a particular kind of talk therapy as a supplement, or changes to your sleep habits. There are so many factors that affect a person’s mental wellness: getting enough good quality sleep, eating well and regularly, exercising frequently, managing stress, and so on. Sleep hygiene is a major problem for Americans in general, and helping you to address that might be one of the most important steps we take.

After you’ve started the medication, don’t feel like you’re on your own. If you’re not tolerating the medicine, let’s talk about what we can do. We would much rather you let us know and we make adjustments rather than you suffering or stopping your treatment on your own (which you should not do). If you have side effects that are concerning you, contact your provider!

What do you think?

Questions for people living with depression and their families: How have your experiences with depression treatment compared to what Dr. Clayton describes? What will you try differently the next time you meet with your (or your loved one’s) provider?

Questions for clinicians: What aspects of this process do you regularly practice? What questions do you have about how you can better tailor depression treatment to each patient?

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Anita H. Clayton, M.D., is the David C. Wilson Professor of Psychiatry, Chair of Psychiatry & Neurobehavioral Sciences, and Professor of Clinical Obstetrics & Gynecology at the University of Virginia, Charlottesville, VA. Dr. Clayton has focused her research on major depressive disorder, mood disorders associated with reproductive-life events in women, sexual dysfunction related to illness and medications, and treatment of primary sexual disorders. She has published over 175 peer-reviewed papers, and developed and validated several measurement tools including the Changes in Sexual Functioning Questionnaire (CSFQ), the Sexual Interest and Desire Inventory (SIDI), and the Decreased Sexual Desire Screener (DSDS).  She co-edited Women’s Mental Health: A Comprehensive Textbook, and is the author of Satisfaction: Women, Sex, and the Quest for Intimacy for the general public.  She has served as President of the International Society for the Study of Women’s Sexual Health (ISSWSH), as Vice-Chair for Women’s Sexual Health for the 3rd and 4th International Consultation on Sexual Medicine in 2009 and 2015, and on the Board of Directors and Scientific Program Committee of the American Society of Clinical Psychopharmacology and ISSWSH.

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