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Using Decision Aids in Depression Treatment: An Update Susan Weinstein, Editor in Chief Care for Your Mind Shared decision making (SDM) is a process requiring accurate information, communication skills, and flexibility. Providers can use decision aids to inform and engage patients and their families

Regardless of the particular symptoms or side effects affecting your loved one, support them in having conversations with their health care provider about these issues to better inform development of the personalized treatment regimen that fits them best. The optimal goal of depression treatment is “full symptomatic remission and recovery of function,” according to Dr. Bradley Gaynes et al., while barriers to achieving remission and recovery include inadequate response to treatment, inability to treat all symptoms, and adverse effects of antidepressant medications as barriers to achieving remission and recovery. We also know, as Dr. Anita Clayton commented recently here on Care for Your Mind, that initial medication success rates are not great: overall, only about 50% of people respond to the first medication and only about 30% achieve remission with their first line of medication treatment. Having a record of symptoms, activities, and treatment adherence (e.g., taking medication regularly as prescribed, following a sleep schedule) supports better clinical care because accurate data allows the health care provider to develop a sense of whether or how well the treatment is working.

The mental health care system is overburdened, so it’s a comfort to know that primary care providers are generally capable of starting a person’s depression treatment. I think everyone can use a questionnaire with their patients and create the framework to discuss all of the aspects of a person’s health and wellness, whether it’s weight, sexual function, concentration, depression, anxiety, or something else. What you can do when there’s no progress with treatment If you are (or your loved one is) not getting better and your primary care provider is not addressing your depression, or not addressing your depression in a way that reflects your preferences and priorities, ask to see a specialist, or a colleague of theirs, or just change your doctor. She has served as President of the International Society for the Study of Women’s Sexual Health (ISSWSH), as Vice-Chair for Women’s Sexual Health for the 3rd and 4th International Consultation on Sexual Medicine in 2009 and 2015, and on the Board of Directors and Scientific Program Committee of the American Society of Clinical Psychopharmacology and ISSWSH.

While screenings are the first step, treatment is the second, and there’s no reason why accessing treatment shouldn’t be a quicker, more effective process for the majority of patients. Some argue that primary care providers (PCPs) don’t have the time, resources, or expertise to deal with patients who screen positive for depression, but there are several ways clinicians — and the system itself — can improve access to care, streamline depression treatment, and help patients get better sooner. If a patient is suicidal or suffering from a more severe mental health issue like bipolar disorder or a psychotic break, the PCP can help the patient access specialized care. If in-person therapy isn’t an option due to cost, insurance, or availability issues, there are reputable online therapy providers and mental health training tools that can help patients learn many of the skills taught in Cognitive Behavioral Therapy (CBT) and other similar behavioral health paradigms.