Compassionate care key to treating depression

I frequently treat adult depression, not only as comorbidity among patients with chronic illness, but also in populations in which basic psychological needs and securities are not met.  After multiple encounters with patients that have similar concerns about depressed feelings typically related to financial and relationship stressors, it becomes difficult to enter into each new patient encounter with the same compassion and understanding.

I recently encountered an adolescent whose mother had brought her in concerned that she was experiencing depression. The mother was very familiar with mental illness and declared that there was a strong family history. She herself was able to recall the list of a number of selective serotonin reuptake inhibitors (SSRIs) she had taken and describe the associated side effects she experienced with each. 

During the exam, the teen was withdrawn and had a flat affect. She made absolutely no eye contact with me and when I questioned her directly, she would look to her mom for an answer. I listened as the mom provided a detailed history of the teen's persistent mood swings, feelings of anger, uncontrollable crying, lack of appetite, increased somnolence, school absenteeism, thoughts of suicide and self-destructive behaviors.

I asked to speak with the teen alone to confirm this history, but this encounter was less than fruitful.  At this time, I recommended that we try medical intervention with weekly follow-up. I prescribed fluoxetine (Prozac) and explained that this medication has been the most widely studied in adolescents, and its long half-life made it an ideal choice for a patient who may not maintain daily compliance. Both mother and teen agreed to this plan.

About a week later, the patient missed her follow-up appointment and I called and left a message indicating that I was concerned about the teen's progress. About three weeks later, the patient's name was on my schedule. I entered into the exam room slightly frustrated, as there had been no communication up until this point.

Upon entering the exam room, I immediately asked how the patient was doing and she promptly gave me a thumbs-up and smiled. This was just the response I needed to remind me that with a small amount of medical intervention and commitment to individual patient compassion it is possible to improve outcomes in depressed patients.

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