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No easy diagnosis for depression

I caught part of an interview with a psychiatrist. The radio talk show subject matter was on depression. He answered questions on the subject of depression from the interviewer and call-ins.

I thought he did an outstanding job differentiating the unique symptomatology of each person who presented symptoms. He focused much attention on major depression where symptoms are generally more magnified and more chronic than situational, short-lived depression.

He focused on what mental health providers explore with questions and observation. One’s daily functioning, including basics such as sleep, appetite, hygiene and moods were identified. Additionally, as I’ve referenced in previous articles, uncharacteristic behaviors are explored by the provider.

An example may include pleasurable activities that have been reduced substantially or else eliminated without just cause. Perhaps an individual attends church weekly like clockwork. The person is known to enjoy this activity. Suddenly, the frequency of church attendance drops to once a month to once every two to three months.

Is that a sign of depression? If family members and/or friends take notice and comment without much explanation? Even then, is that a sign of depression? Once again, many variables need consideration. Speculation and guessing may not clarify this change. Questions asked delicately and with compassion may soon reveal the true nature of the aforementioned characteristic changes. To assume and take off with that truth may exacerbate or worsen the situation at hand.

The interview I referenced brought to light a controversial subject. The doctor said that there’s a proposal to conduct a depression screening with every pregnant woman, especially for postpartum depression. A sticking point is a question of training and willingness for doctors, particularly OBGYN and PCPs, to request the screening or even mandate such. What are the ethical considerations? Unfortunately, I didn’t hear who initiated this proposal.

Additionally, depression screening for young children was discussed. I wonder aloud if the pharmaceutical companies, makers of psychiatric medications, are sponsors. Now, please don’t for a moment think that I’m opposed to screenings. I do believe that considerable numbers of people might benefit from a screening and possible treatment. I’m concerned, however, as to the screening tool, its bias that leans toward a probability of false positives. I do support training for OBGYN and PCP to become more tuned-in to their patients. Herein lies another sticky situation. Doctors who contract with insurance companies are required to offer finite time for visits with some exception. Time is a primary tool to discover a depressed pregnant woman, a depressed elder, a depressed adolescent and so on.

I hope and pray that screenings for depression, anxiety, yes, and even psychosis are performed professionally and properly. Otherwise, consequences of great proportions may subsequently occur. This is a delicate balance. Let there be peace on Earth, and let it begin with me.

Marshall Greenstein, a Cassadaga resident, holds a master’s degree in marriage and family counseling and is a licensed marriage and family counselor and a licensed mental health counselor in New York state. He has regular office hours at Hutton and Greenstein Counseling Services, 501 E. Third St., Suite 2B, Jamestown, 484-7756. Send comments to editorial@observertoday.com

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