PsychEducation.org (home)   

Resources for Primary Care Treatment of Depression and Anxiety 
 (Reorganized and Updated Nov. 2004)

Primary care providers treat at least 50% of the mental health problems in the U.S.^Wells.   And have less time to do it than mental health providers.  And have little support for their efforts.  As a small step toward such support, here are resources selected by and in some cases developed in collaboration with my local primary care colleagues.  

Diagnosis

 Diagnostic Aids
       - Clues on distinguishing ADHD and bipolar disorder in kids-- before using stimulants
        -  Your guide to diagnosis of bipolar variations (treatment too, if you can't refer) 

Screening Tools
        ("How many conditions can a GP screen for?" -- BMJ editorial)

• Bipolar Disorder
  Note that the FDA now says you "should" screen before using an antidepressant, every time.  Until late 2007, this site recommended and made available the MDQ (Mood Disorders Questionnaire). However, this instrument was then copyrighted.  Fortunately, an even better test -- for primary care settings -- is available without copyright. 
  Download the Primary Care MoodCheck

• Depression  
     -  The McArthur Foundation's PHQ-9 -- simple, visual scoring, no advertising 
                 PHQ-9 scoring guidelines
                 McArthur Foundation's Depression Management Tool Kit (lower left hand corner of their home page)
     - Who should get a PHQ-9? A two-question approach with 97% sensitivity (specificity moot if used as gross screen)^{Arroll, full text}
            1. During the past month have you often been bothered by feeling down, depressed, or hopeless?  
            2. During the past month have you often been bothered by little interest or pleasure in doing things?

• Dementia
      - Powerpoint presentation, May 2004, UCSF team reviews dementia screening
      - Their favorite, the Brief Alzheimer's Screen (BAS), described on this slide 
      - Online simple Word document supporting very similar test, from same group
      - Memory testing annually, at home?  Dr. Ashford's (UCSF) online test for same ($10/yr) 

Treatment

Medications: PAR cues, guidelines, lists for patients

• Mood stabilizer "menu" -- if it's a bipolar variant, what med's and risks follow?

• Mood stabilizer instructions -- dosing and other info' for your PAR.

• A  Lithium Augmentation Primer

• lamotrigine PAR elements

• quetiapine (Seroquel) PAR elements

• Antidepressant options -- all evidence-based options to review with your patient.

• Antidepressant medications -- a master list to review with patients.

• Number needed to harm -- antidepressant switch risk in kids

Other Psych' Tools

• My Exercise essay: "Not the Usual Rap" 
    Or you can try  the more typical Exercise: why, how to, how to restart -- three 1-pagers for patients

• Mood charts for your patients to track symptoms while under treatment:
      Paper version (Harvard's chart with minor modifications, like an exercise column)
      Electronic version (very slick, if your patient or her parent uses a computer every day)

Treatment Algorithms

• Texas Medication Algorithm Project

• More effective than "treatment as usual" in controlled trial

• The Depression Algorithm ; and the Project Overview with navigation bar

• Depression Algorithm Doc's manual; a pdf; use bookmarks to navigate

  -- see the "at a glance" summary; and
  -- critical decision-point guidelines (a bit convoluted?)

• Other algorithms: bipolar manic, bipolar depressed

• A Lithium Augmentation Primer (you're right, this is the second time I linked this, hint hint)

• National Institute for Clinical Excellence (advisors to the British National Health Service)

• Project homepage; and the depression guidelines introduction

• Depression: Management in Primary Care
         (Working 2nd draft; a pdf; use elevator shaft to find page #)

- Mild depression: antidepressants explicitly "not recommended" (page 3)
- Moderate-severe depression: medications before therapy (page 4)
- Non-response: explicit antidepressant recommendations (page 5)

Other Treatment Essays

• Antidepressants in bipolar disorder: the controversy

• Light therapy for seasonal affective disorder

• FDA rulings on antidepressant medications

• An essay about alternative or herbal approaches

• An essay for patients about evidence in medicine