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• October 6, 2009 3:41 p.m.

  I am a mental health consumer. For uncomplicated depression, a PCP may be fine. But the patient may have treatment-resistant depression, bipolar affective disorder, or added anxiety for which he/she needs to see a specialist (i.e. a psychiatrist) not only for meds but perhaps more importantly, an accurate diagnosis. Psychiatrists are also more skilled at trial and error with different meds or combinations of meds, much like neurologists do for people with epilepsy. Beware benzodizepines like clonazepam or lorazepam because the dosage must be monitored for habituation and also must be sufficiently high enough of a dose to be effective. Changes to insurance law in the past year have mandated so-called parity for mental health disorders with physical health by insurance companies. Finally, find someone or a mental health agency to help you esp when you start out in this process because the most difficult time of all to ask for help is when you're really depressed. I know that was true for me.

  - Steve

• September 16, 2009 2:07 a.m.

  THIS IS REAL BUMMER ONE WK AGO FINE, PERKY, NOW SAD IS MOVING IN AND I AM UP, NOT SLEEPING VERY ANXIOUS AND VERY SELF CONSCIENCE, MY THOUGHTS ARE RESTLESS AND THOUGHT AT TIMES ARE IMPROPER I HATE MYSELF FOR THINKING BAD I WILL GO TO THE DR AND HOPEFULLY GET SOME PEACE OF MIND SOON. SUFFERING EVERY FALL FOR 10YRS. FAITH HELPS ME TO KNOW THAT GOD DIDN'T MAKE THE WORLD THIS WAY ON PURPOSE. SATAN GOT IN THE WAY BUT HE WILL BE ABYSED AND SOON DESTROYED WHEN GOD INTERVEINS SOON

  - JINI

• September 13, 2009 10:28 p.m.

  I'm very ill..8 doctors..and my family just can't deal with me since I cannot support them anylonger.I shouldn't have to but kids today are different,its a new world of hate out there..and for anyone that can't see the world affairs,the usa is headed for maxist socialism,,how depressing is that here..anyway thanks for lettin me say that no one but blogging friends care,until it is too last so I hope God gives me some more time here. thanks for listening to a not too old lady in her 50's folks.

  - Emily

• September 9, 2009 4:06 p.m.

  As a psychologist and licensed professional counselor, my experience is that most MDs do not know how to treat depression other than with a prescription. With the current wretched state of our health care system, they also don't have the time to actually relate with the person about what is happening in their life and to attempt to understand, empathize, interpret and support. Talk therapy has been shown by research to often provide better results than drugs, either alone or in conjunction, and that's the expertise of mental health therapists. The vast majority of my clients recover from depression without drugs, without having to endure either the side effects or the costs of such treatment. I do often collaborate with primary care physicians to provide coordinated care and often to educate the physician on what I'm doing that's working, to encourage them to support the treatment when they see the client. We have a long way to go before there's parity for mental health care in our overall defective health care system.

  - Dianne

• September 9, 2009 2:09 p.m.

  I agree with Gael. Primary care physicians are great to use as long as you are balanced, but if you have a breakthru mainia or depression one needs a specialist aka someone form mental health. Follow-up is soooo important so that meds can be adjusted early on if needed. My healthcare system allows me to e-mail with my med provider so I keep in touch that way which is great cause then I can avoid an office call.

  - LJ

• September 9, 2009 10:10 a.m.

  I've been on antidepressants for 14 years, have seen several psychiatrists, and am now relying on my internist to prescribe my medications because my psychiatrist closed his practice and moved across the country to Arizona. The biggest problem I have with her is that she doesn't seem to realize that I need a follow-up appointment more often than 6 months. I've had so much experience that I can tell when my dosage needs adjusting, but I worry about newly diagnosed patients being cared for properly by primary care physicians if they just prescribe a pill and don't follow up. When I was first diagnosed with major depression, my psychiatrist saw me every week, then every two weeks, to see how I was doing, adjusting the dose upward as it became clear I needed it. I really think this close follow-up contributed to the successful management of my illness.

  - Gael

• September 8, 2009 8:57 p.m.

  I am fortunate to have a psychiatric nurse practitioner who works with me regarding medication decisions. She is aware of what side effects I have to certain types of meds and we work around the issues. We work as a team and she has earned my trust. This doesn't mean I don't do my own research. Ultimately we as the patients are responsible for our own treatment so we can't be intimidated by the medical community. We know our bodies best.

  - LJ

• September 8, 2009 8:10 p.m.

  Depressions the endure or recur are symptoms of a chronic disease that is not going to be "cured." Meds and cognitive therapy help reduce the symptoms. I have been on Prozac since in was invented 20+ years ago, lithium longer than that. Like with Diabetes meds, there are consequences of long-term use (including weight gain), but they are less severe than letting the diabetes or the depression be untreated and grow worse.

  - Ken

• September 8, 2009 7:11 p.m.

  Getting proper treatment for depression is almost impossible. SSRIs nauseate me and give me flu-like symptoms; psychiatrists don't want to see Medicare patients; my internist seems indifferent. I have no life or enjoyment of anything I used to love and have just withdrawn.

  - dtl

• September 8, 2009 12:26 p.m.

  Hey Blake, what medication were you on that caused weight gain, I'm on one and the Dr. said it didn't cause weight gain but I've gained 30 lbs..

  - DAO

• September 7, 2009 7:17 p.m.

  I called my primary care doctor (internist) and told her I was depressed. My family has a history (1 suicide attempt & several depressed members); we're white-collar, hold excellent jobs, rarely sick, exercise & eat well. She never asked for history or did any physical work-up. She simply asked "Tell me what you think will work and I'll call in the prescription." No thanks. Called my OB/GYN. Told him the same. He said "We don't like to get involved in depression therapy. Check with your primary care doctor." The medical community is really depressing. Ironic.

  - Elaine

• September 5, 2009 12:43 a.m.

  I think it depends on the medication. For instance, one medication I have been on for about 4 years is linked to weight gain, which obviously is unhealthy, and has been also linked to diabetes. So, I would say that taking meds for a long time like this, can be risky (I'm on Zyprexa). In its defense, I've seen first hand, that exercising and dieting can alleviate at least the weight gain. And at some point, the question of what risks you want to take to be "happy" comes into play. If you can do it without the meds, by all means, save your money, but if the patient is unable to function healthily, it can be a god send.

  - Blake

• September 1, 2009 10:49 a.m.

  My husband got a prescription for antidepressants from his primary care doc several years ago. The meds make a world of difference for him (the entire family, really) and I would like him to continue taking them. I wonder how long this is safe, though, and if the primary care doc will simply keep prescribing the meds forever? He doesn't seem to mention any concerns about prolonged use of the meds, he just keeps refilling the prescription. Is this OK?

  - Maureen