This fall, six Michigan-based safety net providers received a combined total of $535,000 to help develop, enhance or expand programs to support uninsured and low-income patients coping with mental illness and substance abuse as a part of Blue Cross' commitment to integrated care. Included in that effort is the treatment of depression. Depression is a condition that often coexists with other chronic diseases and may be mistaken as a symptom of other medical issues, such as diabetes or heart disease, instead of a separate, clinical condition. However, depression adversely impacts the outcome of all chronic medical conditions and should be treated properly. The first step in treating depression is recognizing the symptoms:
- Persistent sad, anxious or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite or weight changes
- Thoughts of death or suicide; suicide attempts
- Restlessness, irritability
- Persistent physical symptoms
Individuals who suspect they may be suffering from depression should make an appointment to talk with their primary care physician or a behavioral health specialist, such as a psychiatrist, psychologist or social worker. Medical professionals may do the following when screening for depression:
- Ask a series of questions.
- Assess for drug and alcohol use, mental health disorders, medical conditions and medication-induced conditions.
- Assess for suicide risk. Individuals with thoughts of suicide should be evaluated immediately by a doctor, emergency department or crisis intervention center.
Treatment of depression often includes:
- Elimination of a medication that’s causing depressive side effects
- Psychotherapy or behavioral therapy
- A “prescription” for exercise and increased social interaction
- Antidepressant medication
If a medication is prescribed, a doctor will monitor the body’s response to the medicine frequently (e.g., every two weeks) and adjust the dosage as needed. Keep the following in mind:
- Abruptly discontinuing medication can be dangerous. Work closely with a doctor when reducing a prescribed dosage, and do so gradually over several weeks.
- Recurrent, severe depression usually requires lifelong treatment.
- It's best to continue medication for at least nine to 12 months after acute symptoms resolve.
Patients who are referred for evidence-based psychotherapy or behavioral therapy should:
- Regularly monitor and assess their treatment plan, goals and progress with a health care provider.
- Maintain ongoing communication with a behavioral health specialist.
- Remember: Overcoming depression can be a long, difficult journey. Don't give up!
Dr. Mary Beth Bolton is medical director of PPO and Care Management for Blue Cross Blue Shield of Michigan. She’s also board certified in internal medicine. If you liked this post, you might also enjoy:
- Beyond the Card: Treating the Whole Person
- Blue Cross Blue Shield of Michigan Foundation Awards More Than $760,000 in Grants to Improve Health Care in Michigan
- Beyond the Card: Expanding Access to Integrated Care {Podcast}
Photo Credit: Ryan Melaugh
