Paul P. Doghramji, MD, FAAFP: Challenges in Major Depressive Disorder

Paul P. Doghramji, MD, FAAFP, cofounder of Brookside Family Practice & Pediatrics, and a current affiliate of Pottstown Medical Specialists, in Pottstown, Pa., sat down with MD Magazine discussing the most important issues that need to be addressed as well as current challenges of major depressive disorder (MDD).

Paul P. Doghramji, MD, FAAFP, cofounder of Brookside Family Practice & Pediatrics, and a current affiliate of Pottstown Medical Specialists:

Primary care depression occurs in at least 15% of our patients, that's a lot. A lot of times patients are presenting with symptoms other than just depression, and it's challenging in primary care to do so, they tend to be. Patients are seen a lot, they are seen for various different conditions. Treating them appropriately with the right kind of medication, plus psychotherapy, behavioral changes is really important.

In the realm of medications a lot of things have come out as far as medications, brand name products that are very, very effective in the treatment of depression, especially some of them that are newer, that also are addressing cognitive function. That's I think one of the interesting areas of depression treatments and also there are several new augmenting medications that have come out in in primary care, so we're getting to be a lot better at getting patients to what's most important with depression treatment, and that's remission, where they don't have any symptoms at all, whether on medication or not.

I think it's been the most exciting thing about depression, is relatively newer medications coming up that are giving us better options for treatment of our patients.

As far as treaments and where there are areas or gaps still, medications have about a 50/50 chance that they will get into a remission. So, still, we have some areas of improvement as to which medications can you use more effectively, have more of a success rate in your mind — we still aren't there.

The second thing is that unfortunately for depression patients are distressed right now, and they've been that way for quite a while. And you're asking them to be patient, wait until the medication does take effect you know in week or two weeks or three weeks. But third is again knowing which medication is the right one for a patient, what kind of testing can we do? Is there a genetic testing we can do to determine which medicine is going to be more appropriate or better suited?

These are some of the challenges that we have in treating patients with depression. The other one that comes up in primary care a lot, other than medication is psychotherapy. That's a very difficult area because often times clinicians are frustrated by not knowing who to refer to, where they can refer to, and patients also find it frustrating because of challenges getting the right psychologist. But mainly, it's the difficulties in finding the right medicine, which is the right one, helping a patient get through that period where they are waiting to see a medication kicking in, and also the fact that the response rates can be a bit on the low side and sometimes you have to increase medication dosages, change medication or augment them. These are some of the challenges.