To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: DG DISPATCH - AAFP: Many Primary Care Patients Experience Depression URL: http://www.pslgroup.com/dg/12C5E2.htm Doctor's Guide September 17, 1999
By Mona Hughes Special to DG News ORLANDO, FL -- September 17, 1999 -- As many as 5 percent of primary care patients experience depression and this is the reason there is a need for family practitioners to be well versed in the use of antidepressants, researchers reported at the American Academy of Family Physicians 1999 Scientific Assembly. Some patients, however, are reluctant to report depression and, as much as 50 percent of the time, prefer to refer to difficulty sleeping, chronic fatigue, headaches, gastric disturbances, mood changes and chronic pain, according to Dr. Richard Branoff, Program Director at Family Practice Residency Program at Halifax Medical Center, Daytona Beach, FL. Symptoms are usually present at least three weeks before they are discussed with the doctor. "Sometimes, a spouse will verify anger in the patient or that he/she is 'not theirself', which can aid in the diagnoses of depression," said Dr. Branoff. "Usually there is a lot of anger involved with depression, admitted or not." "Middle aged men don't realize they are depressed, and often are not in touch with their feelings," Branoff said. Antidepressants are one of the most common class of drugs used in primary care, and there are at least four different subclasses. They are an area of intense research, with eight new ones released in the past eight years. Tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRI) are equally effective for outpatient depression. TCA's may be more effective for severe depression, but adverse reactions such as blurred vision, sedation, weight gain, headaches and exacerbation of glaucoma may make them less desirable for short term use for moderate depression. The TCA class includes Elavil, Sinequan, Imipramine, Pamelor and Norpramin. "The first choice for treating moderate depression should be selective serotonin reuptake inhibitors, with treatment lasting three to nine months," Branoff said. "SSRI's have a low side effect profile and are as effective as TCAs." The SSRI class is Prozac, Zoloft, Paxil and Luvox. Most patients report an improvement in their sleep patterns within a few days and they may experience a heightened pain tolerance. Treatment should last three to nine months and may need to be repeated in 30 percent of patients. Other classes of antidepressants are anxiolytics such as benzodiazepines (Xanax, Ativan and Valium), azapirones (Buspirone) beta blockers (Inderal) and others (Clonidine, Trazodone and Hydroxyzine). --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.