The Role of the Family Physician in Managing Depression

ABSTRACT:
Depression is a common serious but treatable psychiatric disorder that is mostly dealt with in general practice. It is easily missed if the consulted physician is not alert to the tendency of somatisation in this disorder. The family physician plays an important role in the management of depressed patients. Therefore, the physician should be clear about the diagnostic criteria, different modalities of treatment, importance of regular follow up and indications for referral. Evaluating the severity of the illness and the suicidal risk is essential and can save lives. Treatment resistance is common and there are some strategies to overcome this problem. Relapses and recurrence of depression is frequent. 

Key words: Depression, Family physician, Somatisation, Suicide, Antidepressants.

Authors
1-Homoud F. Al-Zuabi, BSc.MBBCh.RCGP. 
Head of Ferdous Health Center
Farwania Primary Health Care Department
Ministry of Health, Kuwait
2-Mai H. Al-Suwayan, BSc.MBBCh.
Public Health Department
Capital Health Area
Ministry of Health, Kuwait

Corresponding Address:
Dr Homoud Fahad Al-Zuabi
P.O.Box: 2326
Ardiya 92400
Tel/Fax: (965) 4883268
E.mail: alzeabi@hotmail.com

 Introduction
In their daily work the family physician faces a lot of psychiatric challenges. Depression is one of the commonest serious but treatable psychiatric diseases seen by the family physician. It has a prevalence of 5 percent for adults in general[1]. Women are affected twice as often as men. The commonest ages are for women 35-55, and for men 45-65. Depression can affect the basic human activities: Energy, Sex, Appetite, Sleep and ability to cope with life[2]. Early detection and management may reduce severity, alleviate distress, and possibly reduce the risk of recurrence or chronicity. General practitioners play a key role in this process since 90 percent of depression is managed in primary care[3]. If depression is not noticed early and treated it may result in catastrophic complications. The family physician is in an excellent position to intervene in depression because of his established rapport with patients[4]. Once the physician detects and treats depression the outlook is very good and this can save lives.

Is it difficult?
It is not easy for any physician to detect every case of depression. Fifty percent of cases are missed at the first consultation. This may deepen depression and patients may develop a negative way of thinking. They may feel hopeless and helpless and may harm themselves or even resort to suicide. There are several factors making depression underdiagnosed and not recognized early in the consultation. These factors may be related to the patient, the family physician or to the clinic. The tendency for somatisation is a very important factor where half of all patients with depression present with common somatic symptoms such as general body pains, headache, backache, dizziness, chest oppression, feeling breathless, tiredness, sweating, palpitation or nausea. To overcome this problem the family physician should always ask about the cause for attendance, patient worries, fears and expectations. This is required more in frequent attenders with simple complaints, multi-complainers and mothers, with a well healthy child using the child as a ticket for admission. 

        Next  Back