The reality is that depression has been extremely underdiagnosed in this country because of the social stigma associated with mental illness. Over the last few years the "chemical imbalance" model has allowed depression at least to be seen on the level of most other "medical" or chronic diseases. There is much less stigma on depression as an illness today, as there was even 10 years ago. The Prozac revolution opened up a whole new world of treatment for many people. And now "big name" people are coming forward to just lend more support that this is a disease that needs treatment. Just today, Terry Bradshaw and Ricky Watters, big names in American football came out on a tv show and spoke how they both have major depression and are undergoing treatment and doing well. That's HUGE!
Most depressed patients don't really meet all the DSM criteria, and no good psychiatrist in practice will hold strictly to DSM criteria because each patient is an individual and the presentation of the disease varies by age, and even ethnicity. This goes for depression, bipolar, et al diagnoses. After practicing for a while you sort of just get "a flavor" for a patient...you don't need to use that checklist.
The Federal Government which determines Medicare physician payment rates does not feel mental illness is worthy of considering mental illness on par with other diseases. In fact, according to Medicare guidelines, Medicare will reimburse a psychiatrist 80% of a normal visit for a mental illness code. Medicare will also reimburse any other physician 60% of that 80% if they put down a psych diagnosis code. Do the math and you will see that means a FP or internist, or pediatrician will get paid 50% of what they normally do for treating depression.
that being said, there are simply not enough mental health professionals to take care of all the patients with mental health needs. You just can't get psych consults, because there may not be a psychiatrist for 50 miles! Family Practitioners, Primary Care Internists and other primary care specialists are treating more patients with depression than psychiatrists! In fact, primary care providers are providing the bulk of the psychiatric care in this country.
I have to disagree with md_student10021 (btw: r u @ cornell? i was in the class of 2000 🙂 ) FPs are WELL TRAINED in managing most "primary care" psychiatric disorders, including depressive disorders, anxiety disorders, bipolar disorder et al. I am completing residency in less than 2 months and I am extremely comfortable with psychotropic medications, as well as providing supportive psychotherapy, family therapy and couples counseling. I have made appropriate referrals for psychiatric admissions, and have had 0 adverse outcomes (i.e. suicide attempts/completions or untreated mania). I treat many depressed, anxious and bipolar patients without the assistance of a psychiatrist, and I usually initiate meds on some of the "really sick patients' that I do send to the psychiatrist, and they usually send the patient right back to me and sign off on the case with no changes because I have the "right" psychopharm for this patient.
I would guesstimate that in my panel of patients (almost 1000 in 3 yrs of residency), about 30-40% have a psychiatric comorbidity, and a lot of them are depressed. I've probably even missed a few.
