W. Clay Jackson, MD, DipTh, on How to Evaluate and Manage Depression

In this video, W. Clay Jackson, MD, DipTh, discusses the management of depression in primary care, a topic he is speaking about at our Practical Updates in Primary Care 2020 Virtual Series on October 9. 

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W. Clay Jackson, MD, DipTh, is an assistant professor of clinical psychiatry and family medicine at the University of Tennessee.


W. Clay Jackson: Hi, my name is Clay Jackson and I am an Assistant Professor of clinical psychiatry and family medicine at the department of Family Medicine and Psychiatry at the University of Tennessee College of Medicine in Memphis, Tennessee. And I am so excited about the upcoming conference.

We're gonna be talking about practical updates in primary care. And if there's anything that I love in my practice, it's finding out practical tips and tools that can enable me to have a better impact on my patients' lives. And fortunately, you know, we have access to lots of CME, lots of meetings, even in a time in our country where we've been experiencing a pandemic. There's a lot of online and in-person opportunities for us to improve our practices.

What I find most helpful, however, is the focus of this conference, where we're taking very common problems such as chronic pain, obesity, IBS, and we're looking at practical tips for how we can improve patients' lives through interventions that can be done in the corner clinic. We're not talking about sort of ivory tower academics, although we will be receiving some of the latest groundbreaking research findings from around the globe. The emphasis of the speakers at this conference is going to be on things that you can take Monday morning in your practice and make a difference to your patients. And so I'm really looking forward to some of those sessions, and I hope that you are as well and I hope you'll join me in learning how we can help our patients. 

So, in the spirit of that idea and theme, my session will be focusing on how we improve the evaluation and management of major depressive disorder (MDD). Now, this is a very common, top 20 diagnosis for those of us in primary care. We see lots of folks with mental illness affective disorders. And major depressive disorder, of course, is one of the leading diagnoses in that category.

And we know that over a given 12 month period, depending on your area of the country and the zip code in which you practice you'll see around 10 to 15% of your patients who may have MDD in a given year. That's sort of the point prevalence for MDD in a practice, so very common.

We'll be looking at a number of different aspects of managing MDD. Starting from how we flip the switch from qualitative management, so somebody has depression, let's treat it with an antidepressant, into more of a quantitative management.  How do we use metrics to guide therapy and practical decision making? How we determine the difference between a response to an intervention versus remission? What's the importance of remission, both at the cellular level, and at the functional level of the whole person?

And then what we do, if our initial pharmacotherapy doesn't work? Do we switch therapies, do we add on something? Either dual therapy with two antidepressants or augmentation with a different sort of a typical agent. What is the role of nutritional therapy? What are the roles of other non pharmacological interventions such as behavioral counseling, exercise? Is there a dose for exercise that we provide for our patients or do we just tell them to get out and walk? We'll be exploring some of these important interventional aspects of how to manage MDD. 

We'll also be focusing on how the clinician-patient relationship is a key driver of adherence to therapy, whether that's pharmacological or non-pharmacological therapy. And how adherence becomes one of the pathways, or doorways, to actually seeing patients get better.

I love treating affective disorder in primary care because it's so rewarding to take patients who have an illness that affects the totality of their lives. It affects their global functioning and their sense of subjective well being. And to see those patients come from darkness to light, as it were. To see them come from a low level of function to a higher level of functioning, to see them come from a low level of enjoyment into a high level of interaction with their family, friends, workspace, religious space, and to become sort of more fully engaged human beings is incredibly rewarding and I hope that you'll see it in the same way.

It can be frustrating because multimodal illnesses do not admit to simple interventions. And so we're going to be looking for practical tips that we can use all along the bio-psycho-social-spiritual model in order to help those patients get better. 

I look forward to seeing you there, we're gonna have a great time, gonna learn a lot of things in a short compact session, and you're going to be able to take that money your clinic and make a difference to your patients. Thanks.