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• W2107283452 abstract "Mrs. Ames* wasn’t doing well. Five months before, she had started to feel sad, fatigued, and disinterested in her work and hobbies. Then came difficulty getting back to sleep when she awoke at 4 AM, a gradual 15-pound weight loss, and growing thoughts about her lack of achievement, worthlessness, and an increasingly bleak future. She began to wonder if it was worth going on living. But she was puzzled. At 47 years of age, she had never experienced anything like this. And her life situation seemed good. Her husband and children appeared to be doing well, she had been promoted in her job, and she had no known health problems. She consulted Dr. Bones, her primary care physician (PCP), an internist, who listened sympathetically to her symptoms, briefly explored her current life situation, examined her, checked out her thyroid parameters and blood counts, and prescribed an average starting dose of an SSRI. At her first follow-up appointment a month later, Mrs. Ames was slightly better. Dr. Bones encouraged her to cheer up and renewed her prescription. Two months later she was no better, so he referred her for psychiatric evaluation. Such a familiar story! Her care in the hands of Dr. Bones, my colleague and friend, had been responsible and correct as far as it went—ruling out medical causes of depression, prescribing an antidepressant, following up at what seemed to him like reasonable intervals. She might have become much worse without it. But the leisurely pace and incompleteness of the care she received had probably cost her several months of amelioration of her suffering. From a psychiatric viewpoint, the initial history had been incomplete. In the 15–20 minute initial appointment, Dr. Bones hadn’t discovered that, when Mrs. Ames was 5 years old, her mother had had a severe postpartum depression or that her maternal grandfather had died under mysterious circumstances. In addition, Dr. Bones had not gone beyond brief screening questions about her marital life or relations with her children. He had not addressed her passing remarks about hot flashes over the past 2 years or lack of interest in sexual relations with her husband. Nor had he explored how her thoughts evolved from the transient idea of not finding life worthwhile to pervasive feelings of hopelessness— especially, was she contemplating suicide? The treatment had been incomplete as well. A followup visit within the first 7–10 days would have been more appropriate; the American Psychiatric Association (APA) Practice Guideline recommends weekly visits for monitoring pharmacotherapy in routine cases, with more frequent follow-up in more complex cases (APA Practice Guideline ,p . 101 ). The dose of the SSRI should have been" @default.
• W2107283452 created "2016-06-24" @default.
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• W2107283452 date "2004-03-01" @default.
• W2107283452 modified "2023-09-25" @default.
• W2107283452 title "Depression, Psychotherapy, and Primary Care" @default.
• W2107283452 cites W2051212068 @default.
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• W2107283452 doi "https://doi.org/10.1097/00131746-200403000-00007" @default.
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