REVIEW ARTICLE

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DEPRESSION IN PRIMARY CARE
PART 2: MANAGEMENT

A patient with complex issues may require referral to a psychologist or psychiatrist who is able to do psychotherapy. These issues would include significant psychosocial stressors, interpersonal difficulties, intrapsychic conflicts and co-morbid personality disorders.⁶ Marital and family therapy may be required for marital discord and family conflict which are a cause or effect of the depressive illness. 

Social Support and Psycho-Education

It is important to assess the patient’s social support and availability of this resource. Supportive relationships assist the depressed patient to recover.  Understanding and gentle encouragement from family and friends contribute to recovery. Family members are also instrumental in helping the patient comply with treatment. 

Psycho education of both patient and family is essential. Depression should be seen as an illness that can be treated. The changes that occur in the depressed person like lack of motivation and impaired functioning can be mistaken for laziness or weakness. Thus awareness should be instilled that these symptoms will subside with adequate treatment. Patient psycho-education should include discussion about the treatment for depression. The properties and side effects of medication should also be discussed.

It needs to be emphasised that the primary care physician can provide a much needed supportive role which includes empathy, effective listening and a relationship with the patient’s family.³

Other Treatments

There are other treatments that can be utilised in the primary care setting. Transcranial magnetic stimulation has been used effectively for some patients with depression.¹¹ It is not invasive and does not require administration of anaesthesia. However, more knowledge regarding the characteristics of patients who benefit from this treatment is required. St. John’s Wort, an extract of the herb Hypericum perforatum, is prescribed in some countries1². It is considered to be safe and effective for relief of mild to moderate depression in adults. Preparations generally are standardised with dosages ranging from 500 to 1,800 mg daily.

CONCLUSION

Managing depression in primary care benefits the patient in many ways. It addresses the suffering and disability which are a consequence of the illness. Furthermore, the stigma associated with being treated by a psychiatrist is reduced. Primary care physicians and general practitioners should be encouraged to embrace this challenge.

References

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