BENGALURU: My primary care physician gave me an antidepressant and I don’t feel much better. Is there any point in seeing a psychiatrist?
You should see a psychiatrist if symptoms are not improving. A thorough psychiatric assessment would be done and appropriate treatment started which would include medicines and psychotherapy. If you have not improved despite treatment, your diagnosis needs to be made again, right medicine in right dose to be taken for sufficient length of time. After that, assessment would be done again. The effect of medicines comes after few weeks generally.
My doctor has recommended that I take an antidepressant, but I don’t have depression, I have anxiety. Why is this the treatment he / she wants me to use?
Most antidepressants are also anxiolytics. Medicines have many other effects too, such as sleep induction and effects on sex life. To prevent this confusion, as you have, medicines are called by their chemical structure and functions, like tricyclics, SSRIs, SNRIs and benzodiazepines. Also, commonly anxiety and depression occur together. Patient notices those symptoms which are more disabling. It is possible that your doctor noticed both symptoms. To prevent such confusion, psycho education is given to the patients and the family.
There are many different kinds of new medications that deal with depression - what guidelines do doctors use to determine what someone should be on?
This is a very good question. While prescribing medicines, the doctor keeps symptoms in mind, assesses the possibility to harm the self, and enquires about substance use. The diagnosis is done on the basis of age, weight, other physical parameters, presence of other medical conditions, pregnancy, lactation, risk-benefit analysis, possibilities of serious and non- serious side effects of the different medicines, previous exposure to the medicine and its effects, presence of family history of psychiatric disorder and its treatment. And whether electroconvulsive therapy is needed. All these points are discussed with the patient and family, their questions are answered and a treatment plan is charted out and executed. Very often, interpersonal and family issues are also addressed as part of the treatment.
It is important to note that in most cases, symptoms take time to improve, treatment is taken for long which continues even after symptoms have improved. Regular visits to the doctor is important. Without his advice, medicines must not be stopped otherwise there might be relapse.
– Consultant Psychiatrist, Manipal Hospitals Bengaluru
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