The purpose of this tool is to help you decide whether or not to see a depression specialist. When making a decision like this, you must balance:
- The reasons for seeing the specialist
- Whether there are alternatives that may be more appropriate
This tool is not a substitute for professional medical care and advice. Ask your regular doctor to help you decide whether it is worth seeing a specialist. There is usually no exact “right” or “wrong” answer.
Your doctor may make certain recommendations to you. However, the final decision about whether to see a specialist rests with you.
What is the specialist?
Depression is feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. But true clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life.
Depression is a treatable illness, with many therapeutic options available. Increasingly, professionals are viewing major depression as a chronic illness, meaning the condition nearly always returns when treatment is stopped. Therefore, medical treatment must be ongoing.
Patients with chronic depression usually need to see a specialist. This may include a psychiatrist, who specialize in prescribing medications for mental health disorders such as depression. Most patients also benefit from seeing a talk therapist, typically a psychotherapist. This specialist may be a psychologist, a social worker with a masters degree, a nurse practitioner or advanced practice psychiatric nurse, or other mental health professionals with at least a masters degree. Cognitive behavioral therapy or interpersonal therapy are the most common types of talk therapy.
Cognitive therapy may be particularly helpful for the following people:
- Patients with atypical depression
- Most adults with mild depression
- Adolescents with major depression who have mild symptoms
- Women with non-psychotic postpartum depression
- Children of parents with depression -- in this case, therapy should involve the whole family
- Cognitive behavior therapy may work as well as antidepressants in treating severe depression for many patients. However, patients with moderate or severe depression often also need medication.
- The benefits of this therapy may continue even after treatment has ended.
- Cognitive behavior therapy is also useful for treating other psychiatric problems often found in people with depression, such as anxiety.
- Most people with depression can be treated in an office setting by a psychiatrist or other therapist.
- The patient should describe problems briefly but specifically over the phone to any prospective therapist to get a sense of whether the therapist will suit the patient's needs.
- Patients should not be shy about considering a change in their therapist if they lack confidence in their current one.
- Often, depression specialists (psychiatrists, psychologists, and counselors) do not accept insurance and require you to pay for the cost of your care.
How much time this decision tool will take
What this tool will provide
- A personalized list of factors for you to weigh
- Questions to ask your doctor
- Alternatives to seeing a specialist
- Recommended reading
Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
- Institute for Clinical Systems Improvement. Health Care Guideline: Major Depression in Adults in Primary Care. Tenth addition. May 2007.
- Rohan KJ, Roecklein KA, Tierney Lindsey K, et al. A randomized controlled trial of cognitive-behavioral therapy, light therapy, and their combination for seasonal affective disorder. J Consult Clin Psychol. Jun 2007;75(3):489-500.
- Zuckerbrot RA, Cheung AH, Jensen PS, Stein RE, Laraque D; GLAD-PC Steering Group. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics. Nov 2007;120(5):e1299-312.
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