There is a worrying lack of adequate treatment for depression. But why is this? In a nutshell – not enough psychiatrists to go round. This means general practitioners (GPs) have to pick up the slack – and GPs are not mental health specialists.
I’m going to explore this deplorable state of affairs in depth. I will start by summarising the current state of depression treatment. I will then outline why there is a shortfall of psychiatrists. Finally, I will explain the shortcomings of GPs when treating depression.
Okay, first up . . .
Current State of Depression Treatment
Only about 40 percent of people treated for depression get adequate treatment. The main reason is that general practitioners (GPs) tend to be the first line of defence against mental illnesses.
They are not as well informed about depression as mental health specialists (psychiatrists).
Therefore, they are more likely to treat it incorrectly. They often prescribe too low a dose of an antidepressant. They sometimes even prescribe inappropriate medication, such as an anti-anxiety drug.
GPs treat around 70 percent of the people who seek help for depression. And more of them are treating depression now than a decade ago. That’s because the newer antidepressants (SSRIs) are safer and easier to prescribe than older drugs.
Shortage of Psychiatrists
Unfortunately, there just aren’t enough psychiatrists to go round. Without GPs, they wouldn’t make a dent in the number of people with depression. Sadly, this is unlikely to change.
There are a number of reasons for this shortage.
In the past, stigma and misunderstanding of mental illness was a real issue. This led to insufficient funding. As a result, psychiatrists were often paid less than other specialists. Sadly, this discouraged many doctors from entering the mental health field.
Another reason is the “retirement drain” on the numbers of psychiatrists. Over 60% of psychiatrists are aged 55 or older. This is the highest percentage out of all the specialist fields.
There has been a greater awareness of mental illness in recent years. As a result, there is now a lot less of a stigma to mental illness. This has encouraged more people to seek treatment. Ironically, this has added to the problem by increasing the number who seek treatment.
GPs Not Qualified
Let me be blunt. GPs are not qualified to treat depression. Everybody with depression should be treated by a mental health specialist. In other words, they need to see a psychiatrist.
You wouldn’t expect a GP to prescribe chemotherapy if you had cancer. Likewise, you don’t want one to prescribe medication for something as serious as depression. Even so-called “mild” depression is anything but. And it can get worse.
GPs Not Up To The Job
Many patients don’t receive adequate care from GPs, even for mild or moderate depression. This happens for a number of reasons.
Lack of Training
GPs don’t receive enough training on how to recognise depression. Many patients don’t tell their doctor they are sad or depressed. Instead they complain about physical symptoms of depression. For example, fatigue or insomnia.
Because of this, many doctors just treat the physical symptoms. They don’t consider the underlying causes.
Lack of Communication
When a GP correctly diagnoses depression, an antidepressant is usually prescribed. However, they rarely prepare the patient for potential side effects. Yet unpleasant side effects like anxiety, weight gain and loss of sex drive are one of the main reasons patients stop taking antidepressants.
Side effects can start within a day or two of beginning an antidepressant. However, the benefits often take several weeks to kick in. Many patients complain that they feel worse after starting an antidepressant. As a result, GPs will often switch them onto another antidepressant.
However, side effects are often only temporary. If GPs explained this to their patients, many more would continue treatment. As a result, their depression could be effectively managed.
Lack of Expertise
Finally, most GPs just don’t have the expertise. They don’t fully understand the nuances of the many antidepressants. For example, which ones are best for particular symptoms. Or what to do if the lowest dose doesn’t work.
So, I’ve explored why the current state of depression treatment is so inadequate. I’ve touched on each of the following topics:
- current state of depression treatment
- why there is a shortage of psychiatrists
- shortcomings of GPs
If this state of affairs continues, Society will pay a heavy price. There will be more (avoidable) suicides and higher levels of disability.
In closing, there is one thing I want to make clear. I am not criticising GPs. All I’m saying is that they are not qualified to treat depression. And it’s not fair to expect them to.
Okay, I’ve had my say – now it’s your turn. Let me know what you think in the comments section below . . .