What is the best treatment for depression?

There are many different kinds of depression. Depression is usually not simple. There are usually underlying issues making it complicated. A person might be depressed because they’re socially isolated because they simply don’t have good social skills. That would tilt that person‘s treatment towards seeing a psychiatrist who can help with social anxiety, perhaps with medication, and seeing another person for psychotherapy, someone specializing in interpersonal therapy.

A common way to get some information quickly about what works is to ask friends and family who have been depressed, what did they do that worked? What medication? What kind of counseling? What psychiatrist? What psychologist? Then research that on the Internet. Don’t be an easy sell. Be skeptical. There can be adverse side effects to certain treatments. Do you want your treatment to be guided by an experienced clinician? How do you find that person? Again ask people you know if they have had a good experience with the provider. You can also ask your primary care doctor or pastor. Sometimes people will ask friends at work, as long as they know that friend will keep the conversation secret.

When you find the name of a provider, then you can look at that provider’s website. There are many, shall I say, inexperienced providers. Some only work in the virtual space, providing only video visits. They don’t see people in person. That works for some people in remote areas but that really limits your options because 90% of communication is nonverbal. The doctor may have years of experience, but your experience with that doctor is going to be limited by just doing video visits.

Try to find a provider who has his or her office in your town. If you Google search “psychiatrist in (your town) you will likely first get a bunch of ads, like I’ve mentioned elsewhere. The search results can include: psychotherapists, psychologists, neurologists, family doctors and somewhere in the mix are psychiatrists. So don’t be put off by the confusing results. Google is good, you just have to know how to work with it. Expert tip: go to Google Maps and search “psychiatrist near me.” Near as I can tell, these search results so far will actually tell you the psychiatrists near you and there will be little red marks on the map of your town, with apparently little or no influence from ads.

Then just click on the links to the doctors and see what the doctors say about themselves. Go to their website. Look at the pictures of the office. Is it comfortable and inviting? That shows the provider has a sense for what it takes to make patients comfortable. Does the provider have pictures of himself or herself smiling? That’s usually a good sign. Some providers are overly serious and that can be offputting in the psychotherapeutic interaction. You want to find a provider who is warm and caring, sincere, and experienced. The website should say something about how long that provider has been practicing and where they have practiced.

Side note: the July 2024 Journal of the American Medical Association (JAMA) had an interesting article on doctors and their personal conscience. Doctors take an oath to put patient care first and do no harm. But sometimes in conflict with that is corporations (HMO’s, and hospitals and clinics) that have their collective “conscience” or list of do’s and don’ts. You can see that reflected in the website. Does the website have little in terms of the doctor’s individual comments on topics? Is there limited ability for the doctor to express himself and his philosophy of practicing medicine? That might (or might not) reflect a corporation exerting control over what the doctor does and says. I experienced alot of that in my training and working at 19 different hospitals. The JAMA article took a dim view (obviously) of corporations limiting what doctor’s can do in the doctor’s conscience. It also noted a large percentage of doctors now work under the control of large corporations (over 50%). A small percentage of doctors (and especially psychiatrists) remain free to practice in light of their own conscience with less influence from others. I estimate the number of psychiatrists in private practice in my area as less than 20%. I am a doctor in private practice since 1996 so it’s no wonder this is my bias, but of course you, the reader, can think about this as you wish. Blogs let you write your personal opinion, so here is mine! I invite your to think for yourself, that’s the great thing about this country, people are free to disagree and change their minds as they see fit.

Back to the process of selecting a provider.

Key Factors In Picking A Doctor

You want the provider to share experience with your culture. If you are from a certain ethnicity and culture, that the other person knows nothing about, that may create issues. It might not. But certainly that would be something to bring up, how the provider knows about your culture, and could some time be spent communicating about that, to facilitate a good Dr, patient relationship.

The provider’s website should also acknowledge what specialties they have. Also, if there’s certain medicines they don’t prescribe. For example, I had a patient see me want to a certain kind of medication that I don’t prescribe. I don’t have all the government regulations for that specific medication. I tried several hours, but the red tape was awful. And most people don’t need that medication. On the other hand that patient really wanted that medicine prescribed but they never asked ahead of time if I prescribed it. So they paid for a new patient visit and were disappointed. I wanted to help them, but I don’t have the legal permission to prescribe that medication. So it pays to research exactly what you want and communicate that to providers ahead of time.

Some providers don’t prescribe stimulants. Often a first prescription of a stimulant requires an in person visit, and they don’t do in person visits. Some providers don’t prescribe buprenorphine or other medicines for narcotic addiction. That requires a special permission and special training. If you want that kind of medicine, you should ask ahead of time if the doctor prescribes it.

If you have borderline personality disorder or other personality disorders, you should ask ahead of time if the doctor works with it. Borderline personality disorder gets better with dialectical behavioral therapy and sometimes (not often) use of medication. I do a little DBT but for that personality, a person should work with a therapist who specializes in DBT. I would support your learning of DBT skills and maybe add in teach meditation for sleep or meditation for self acceptance skills if a person wanted to learn that. If you are wanting certain things from the court, such as a legal psychiatric evaluation, you should ask ahead of time. A forensic evaluation is an exam that can only be provided by a forensic psychiatrist. And by the way, I’m not a forensic psychiatrist!

So a person with a little research can have a good chance of finding a provider who matches up with what they need. It takes doing a little talking around with friends and family, fact,checking certain things, and then looking things up on the Internet. You might also want to Mmet with several providers and then just pick the one that you have the best connection with. I often see that being done.

That’s why there are a number of different providers in a community with different training and skills, so you can pick and choose between them.

I recently met with my primary care doctor. He prescribes me a medication for high blood pressure, and another for high cholesterol. OK. I have problems but I am dealing with them! I suggested a different medication for high blood pressure. He informed me I was wrong but he just referred to scientific studies about what medication has the best results. He didn’t say I was wrong, ha ha. He just said the results are best with 2 or 3 other medications and then left the choice up to me. Quite artful. I felt in control of my part in my medical care, and quite well taken care of. Now my blood pressure and cholesterol are fine, but I have a great level of confidence in my primary care provider for respecting my opinion, informing me about the science behind different medications, and then leaving the ultimate choice of medications (that were reasonable) up to me. He got me out of the visit on time and I was on time for my next visit with my patient. So he’s earned my confidence. But I did my research before I picked him. I’m sure you will too.