Dr. Dresner expains the stigma surrounding depression.
That is an important question; it’s a great question. You would think in 2008 we have many, many individuals in the media who have acknowledged their depressive episodes and their treatment for depression. We are a society that advocates for parity in mental health treatment, and mental health coverage, but nonetheless, acknowledging psychiatric illness, psychological distress, is still a huge, huge problem in our society.
It is extremely difficult for men, especially, to acknowledge psychological distress. Men tend to have more problems with drugs and alcohol. Women tend to be diagnosed more often with depression and anxiety. Interestingly, stigma plays a role in directing patients, not to psychiatrists and mental health providers, but to their primary care providers for intervention. People with headaches, with back pain, with tension of some kind or another, are much more comfortable presenting to their obstetrician or to their internist or their family practitioner with those complains than they are calling up, looking in the Yellow Pages, or asking for a referral to a psychiatrist.
Psychiatrist seems like that’s somebody for really sick people, for really serious problems. So frequently, in fact, primary care doctors, internists, family practitioners, obstetricians write far more prescription. The vast majority of prescriptions for antidepressants and anti-anxiety medications come from those providers and not from psychiatrists.
So the vast majority of treatment for depression and anxiety comes from the primary care arena, and so it’s extremely important for primary care providers to be knowledgeable, but they are seeing 30 patients a day potentially, and they don’t have the time necessarily or the expertise to get a detailed history, to sort of look at what the big picture is, to assess psychological, you know, do a really comprehensive bio-psychosocial assessment.
What are biological factors, genetic factors, historic factors, have you ever been treated before? What’s going on emotionally with you? What stressors are going on in your life? What’s going on in your work environment and in your family?
Frequently, a patient will come in to a doctor for some complaint and start to cry, and the doctor is thinking, “Oh no, I only have three more minutes,” wanting to provide some sort of relief or intervention for the patient but again maybe feeling a bit overwhelmed by their presentation.
So and just to sort of give an example, Fluoxetine was brought to market in the late 1980s as Prozac, and Prozac was the most prescribed medication for ages and ages, next to benzodiazepines or Zanax.
So psychotropic medications are very highly prescribed medications, and in the late 90s, the corporation that manufactures Fluoxetine as Prozac got an indication to treat premenstrual dysphoric disorder, PMDD, a hormonally mediated depression that occurs before menses with the same agent.
Instead of marketing it as Prozac, they changed the name to Sarafem. They put it in a package that looks like birth control pills, in a pink package, and the label had a big daisy on it. So it’s a very feminine, feminized version of Prozac that was now being marketed to OB/GYNs and primary care doctors as a treatment for PMDD.
So when patients come in to their doctor and complain of depressive symptoms or premenstrual symptoms, they’re going to be prescribed this new drug, this new agent called Sarafem, not Prozac; that’s for psychiatric patients. Sarafem is for our female patients with some kind of hormonally-mediated mood disorder, and it was very well received and very highly prescribed.
It was a way to cast the net to individuals who, because of stigma, would not seek psychiatric treatment but would accept this treatment from their primary care provider because it seemed like an intervention, sort of a biological intervention for a biological problem that they were having.
About Dr. Nehama Dresner, M.D.:
Dr. Nehama Dresner, M.D., is a licensed, Board-certified psychiatrist (in general psychiatry and psychosomatic medicine) with specialized training and nearly 20 years experience in Women's Mental Health and Medical Psychiatry. She is Associate Professor of Clinical Psychiatry and Obstetrics/Gynecology at Northwestern University Feinberg School of Medicine and is actively involved in medical education. A fellow in the Academy of Psychosomatic Medicine and the America Psychiatric Association, she speaks locally and nationally on issues related to psychological aspects of women's health and medical psychiatry. Dr. Dresner's clinical specialty is psychosomatic obstetrics, and gynecology, women's emotional development, and psychiatric treatment of the medically ill.