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Should I use a Therapist or Family Doctor?
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Break an leg, and you head for the emergency room. Nagging cough, you see an internist or family doctor. But where should a depressed person turn for help when, as our questionnaire put it, emotional problems make life “usually pretty tough” or when he or she can “barely manage to deal with things”? The answer is crucial to the type of treatment received and its success. “People may not go to the doctor and say, ‘Hey, I'm depressed.' Often they show up saying, ‘I can't sleep, I have stomach problems, my head hurts, my back hurts, “ says Michael Schoenbaum, Ph.D., a RAND Corporation health economist whose work focuses on improving the treatment of depression. If you're not sure what the problem is, a family doctor might be the logical first stop in seeking care, but perhaps not the only stop for those with severe symptoms. While treatment outcomes from primary-care doctors were nearly as good as from therapists for people who said they started out with less severe symptoms, treatment by mental-health specialists yielded significantly better results for people who started out in poor shape. Had trouble getting care? WHO Gale Burstein, 40, Decatur, Ga. WHAT HAPPENED Burstein, a pediatrician specializing in adolescent health, recognized she had the symptoms of postpartum depression. She says that shortly after the birth of her second child, three years ago, she urgently needed help. But when she called the 800 number on her health insurance plan card, she got a runaround and could not obtain authorization for treatment. Reluctantly, she had to reveal her need to a human resources staffer at her workplace, who informed her that her health plan had turned over mental-heath benefits to another company to administer--using an 800 number not listed on her card. Six months' treatment with Effexor, prescribed by a psychiatrist, brought her to the point where “finally, life was good.” And indeed, in our study, people who saw only a primary-care physician tended to have milder symptoms, and most had six or fewer treatment visits. “Mostly drugs” was the type of therapy described by almost half of those who saw only a primary-care physician and 38 percent of those who saw a psychiatrist. The “mostly drugs” group typically received a prescription antidepressant. The few doctor visits they had were probably largely devoted to monitoring how well the medicine was working and checking for side effects. Others who saw only a primary-care physician received a combination of advice and medication. Experts we interviewed noted that many independent studies have documented the less effective mental-health treatment delivered by primary-care doctors. “Your primary-care doctor has a million things to do and not a lot of time to see you, and in general does not have much training in diagnosing and treating mental illness,” Schoenbaum says.


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