Primary-Care Doctors Don’t Have the Best Tools for Treating Depression

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Not all doctors are able to treat depression effectively, including those who are most likely to see patients’ first symptoms.

Even though patients may turn first to their primary-care physicians with any concerns about depression, the tools that those doctors use to evaluate their patients for mental-health disorders aren’t necessarily helping to improve their patients’ symptoms, according to the latest study published in the Journal of the American Medical Association of some of the most common practices used by these physicians.

Researchers from the University of California, Davis, looked at techniques, designed for patients, that help primary-care physicians to assess mental-health symptoms more easily in a doctor’s office or even the waiting room. The depression engagement video (DEV) helps patients to identify depression and guides them on how to talk to their doctors about symptoms. The¬†interactive multimedia computer program (IMCP) similarly helps patients to recognize and discuss depression with their doctors, via an interactive program that gives them feedback about their symptoms and their level of depression.

Among 925 adult patients treated by 135 primary-care doctors in the study, 603 patients were already diagnosed with depression and 322 patients did not show signs of the condition. All the patients were randomly assigned to either of the two digital assessments, or to a control group, and then followed up 12 weeks later to see if the interventions improved the patients’ mental-health symptoms.

Doctors were more likely to offer referrals to mental-health programs or antidepressant medications after evaluating patients using the DEV or IMCP, at rates of 17.5 % and 26%, respectively, compared with those who didn’t rely on the programs. And patients¬†were more likely to ask for information from their doctors about depression if they used the tools.

That did not mean, however, that the patients who were referred to additional services such as seeing a therapist or prescribed medications fared better than those in the control group. When the researchers assessed the participants’ depression symptoms 12 weeks later using a questionnaire, they found that those who received the additional services and those who did not scored similarly on the mental-health evaluation. So while the strategies may appear to help primary-care doctors to better assess depression, the researchers say the tools may not be as effective as hoped for matching the right treatments to the right patients in order to improve their symptoms. And that, potentially, could lead to worsening symptoms and deeper depression. “Further research is needed to determine effects on clinical outcomes and whether the benefits outweigh possible harms,” the authors write.