We recently spoke with Shel Schneider, Ph.D., M.S.W. about his role in managing depression.  He is a board certified therapist and has over forty years experience working with psychiatrists.

When you first see a patient, what is your job?

Well, before anything else, a therapist must put the patient at ease and determine what has brought them in today.  This would include taking a family history.  It is often helpful to see family members as well.  If the patient has clinical depression, versus, say, a reactive depression, I make sure they have been seen by a psychiatrist. My job during this phase is to support the patient while they work with their doctor.

What is your number one priority when you see a new patient?

It is important to stabilize the person who needs pharmacological intervention.  This requires attention to the patient's concerns.  I help answer questions such as: "What if the first medication doesn't work?"  If that happens, this person is going to be frustrated and in need of additional support.

There is also the issue of side effect management.  I like to make sure the patient and doctor are communicating.  I keep in contact with the physician.  It is important that one knows which are transitional side effects versus more serious ones.

What about those on more than one medication?

Some people are on several medications which can be uncomfortable.  Multiple medications may cause financial burden and result in stress.  I help put them at east.  All of this is a part of psychoeducation.

Psychoeducation?

When a person is diagnosed with any illness, they are thrown into a new level of concern.  It is one thing to understand that clinical depression exists; it is another to have it.  I can help someone explain the illness to hir family, understand what is going on in hir body, and discern what is important to discuss with hir doctors.  It is also important they realize that my confidentiality extends to discussions with their doctor.

What role do you play after someone has been stabilized?

Long term management issues can change.  This is partially because the illness can change.  There are always difficulties surrounding taking medication long term.  I help people deal with he idea that they may still be sick even if they feel well.

What if a patient has been doing well and wants to go off hir medication?

The first thing I tell them is to have this conversation with their doctor.  If your therapist suggests that you stop taking your medications without first consulting your physician -- get a new therapist.  There are many possible outcomes of such a decision.  The worst case is that a person can relapse, try to go back on the medication and it no longer works!  Imagine having to start at square one all over again.  A person has to learn the responsibility of managing their illness.