CityView Magazine

NOW ACCEPTING NEW PATIENTS Dr. Patrice Barber General Dentist didn’t have great evidence about treatment strategies. Most pharmaceutical trials aren’t applicable to the real world: they typically study one medication at a time; patients are recruited and have few or no psychiatric co-morbidities such as anxiety or substance- abuse problems; only the most severely depressed patients are entered in the trials and once they’re enrolled, patients usually have no say in their treatment choice. The National Institute of Mental Health recently completed the STAR*D trial, short for Sequenced Treatment Alternatives to Relieve Depression, to give us more real- world answers to the question of how to treat depressed patients. All patients who complained of depression, even those with mild and moderate cases, were enrolled and at several points in the trial they had choices about their treatment. The study’s conclusions are many: • Antidepressants don’t work as well in the real world as they do in ideal study conditions Because All Dentists Are Not The Same • Adding a second anti-depressant or switching to a different one does help though adding or switching medications a second or third time doesn’t help as much • Adding counseling or switching from medication to counseling was as effective as changing medications • At the end of the study, two-thirds of patients were essentially symptom-free. What does this mean for you? Pay attention to your feelings. If you think you might 5428 Yadkin Road 910.868.4664 alliancefamilydental.com be depressed, see your doctor. If you are prescribed medication, stick with it for 14 weeks, but even if you can’t see a change, don’t give up. Tell your doctor and ask to switch medications, add medication or get counseling. Don’t settle for improvement, seek remission. Exercise helps you feel better, drinking alcohol makes depression worse. Cognitive behavioral therapy, the type of counseling studied in the STAR*D trial, is a good substitute for or adjunct to medications.CV Dr. Lenny Salzberg sees patients and teaches at the Southern Regional AHEC Family Medicine Center. Signs of depression SIGECAPSS = Depression S – Feeling sad, depressed or hopeless I – Little interest or pleasure in doing things that you used to enjoy (anhedonia) G – Feeling worthlessness or having excessive or inappropriate guilt E – Fatigue or loss of energy C – Decreased ability to concentrate or make decisions A – Significant change in weight without trying (appetite) P – Observable physical sluggishness (psychomotor retardation) S – Inability to sleep or excessive sleep S – Recurrent thoughts of death (suicidality). Don’t tough out depression on your own. If you have four of the above symptoms, you meet the DSM-IV criteria for Major Depression. These symptoms need to be a change from how you usually function and cause significant distress or impairment. Cognitive Behavioral Therapy This is the type of counseling typically recommended for depression. CBT is time-intensive and is usually provided by psychologists but can also be done by other licensed mental health counselors. There are few side effects (if any) with CBT and it is generally well-accepted. There is a lower relapse rate with CBT when it is discontinued than when medication is discontinued. Some disadvantages of CBT: it requires more effort than taking a pill and insurance coverage is more variable. 66 | Aug/Sept • 2010

• Cover