Addressing Mental Health in Primary Care

Screening and Identification

Routine depression screening (PHQ-2/9) detects many cases missed in busy practices. Anxiety disorders often manifest with physical symptoms like palpitations or GI distress. Two-question screens for each condition facilitate rapid identification during routine visits.

Initial Management

SSRIs remain first-line for both depression and anxiety, starting low and titrating gradually. Cognitive behavioral therapy techniques can be introduced during office visits. Exercise prescriptions (30 min 3x/week) provide comparable benefit to medications for mild-moderate depression.

Collaborative Care

Integrated behavioral health specialists improve outcomes for complex cases. Warm handoffs to therapists increase follow-through with referrals. Telepsychiatry expands access in resource-limited areas. Regular follow-up (2-4 weeks initially) assesses response and side effects.

Medication Considerations

Select medications based on side effect profiles (sedating vs activating). Monitor for initial anxiety worsening with SSRIs. Most medications require 4-6 weeks for full effect. Combining medication with lifestyle changes often yields best results.

When to Refer

Indications for psychiatry referral include treatment resistance, bipolar features, active suicidal ideation, or complex comorbidities. Emergency evaluation is warranted for imminent safety concerns. Ongoing communication between providers optimizes care coordination.