Can your patient remember what they just read? How cognitive tasks can inform antidepressant dosage—and other useful tips.
To help reduce these alarming statistics, psychiatrist and Clinical Associate Professor at the University of Melbourne David Horgan says GPs can use a simple reading question he has found to be highly reliable in over 10,000 episodes of depression.
“Can the patient remember what they read? Unhappy people can concentrate and remember the core theme. Depressed people cannot,” Associate Professor Horgan says.
“As depression becomes more severe, patients will report they cannot read one page of an article, or for high IQ people their memory is not as razor sharp as usual.”
This question can also be used to titrate antidepressant dosages. If a patient on antidepressants forgets words or finds difficulty expressing themselves, Associate Professor Horgan says they should reduce their dose.
“Patients think they are getting depressed again, when in fact the antidepressant is markedly effective,” he says. “A reduction in dosage usually resolves the issue within 48-72 hours.
“In contrast, if the patient has impaired concentration but can remember words, I advise patients to increase their dosage, with results obvious in 48-72 hours.”
According to published research, the benchmark for confirming the effectiveness of a particular antidepressant is two weeks.
“If there’s no light at the end of the tunnel at two weeks, it is 80-90% certain that that antidepressant will never work and you should consider moving on to the next one,” Associate Professor Horgan says.
“If after about four weeks an antidepressant works, then the patient should be able to read and remember. If not, push up the dose or increase the power of the antidepressant.”
“For example, there is very good literature that says adding 1-4 milligrams of Sifrol or Simipex at night improves depression in about 50-70% of people already on antidepressants.”
Associate Professor Horgan says another useful resource to be aware of is InToughTimesText.org. The website, which will soon also be available as an app, provides specialist-approved messages and phrasing that family and friends can use to talk to or text someone experiencing suicidal thoughts.
The suggested phrasing can also be helpful for GPs to use with patients who are dealing with suicidal ideation.
For example, one phrase from the website that Associate Professor Horgan uses in his practice is: if you had a friend with your problems, would you advise him or her to kill themself?
“Of course they wouldn’t,” he says. “Then why are they thinking about it?”
To hear more practical tips from Clinical Associate Professor David Horgan, register here for Healthed’s upcoming webinar, where he will speak on Managing Depression in Primary Care – Lessons from 10,000 Patients.
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