Psychiatric Evaluation Program Finds Appropriate Treatments for Complex Conditions

Angela, a 47-year-old resident of Athens, Georgia, has suffered from depression since childhood, with frequent thoughts of suicide. In the past 15 years, her doctors, who were not trained in psychiatry, prescribed approximately 20 different drugs. None were effective, and one antidepressant had serious side effects on her vision.

Fortunately, Angela was referred to a program at the University of Miami Miller School of Medicine’s Department of Psychiatry and Behavioral Sciences that specializes in treating patients who have not responded well to traditional drugs and therapy. The Comprehensive Diagnostic and Treatment Evaluation Program incorporates a three-day evaluation conducted by a team of physicians, psychologists and therapists who are chosen based on the patient’s chief symptoms.

More than 400 patients like Angela have been evaluated in this program, which offers hope to individuals who suffer from long-term depression. The U.S. Centers for Disease Control and Prevention estimates that one in 20 Americans age 12 or over reports current depression.

“The majority of patients with depression are treated by non-psychiatric physicians,” said Charles B. Nemeroff, M.D., Ph.D., Leonard M. Miller Professor and Chairman of the Department of Psychiatry and Behavioral Sciences, clinical director of the Center on Aging, and chief of psychiatry at Jackson Memorial Hospital and University of Miami Hospital. “Our comprehensive program is unique in the nation as it addresses complicated patients or those who have failed previous treatments.”

During the evaluation, a neuropsychologist performs extensive testing and a psychologist meets with family members. Once completed, all of the faculty, including Nemeroff, meet in conference to arrive at a consensus diagnosis and treatment plan.

When she entered the program two years ago, Angela was assigned to Jeffrey Newport, M.D., professor and director of the Women’s Reproductive Mental Health program.

“I really liked Dr. Newport,” Angela said. “He knew what to ask and said things that I had never thought about before. This was the first time this ever happened to me.”

Newport recognized that Angela was suffering from panic disorder and social anxiety disorder, as well as depression.

“Angela had previously been treated with seven different antidepressants,” Newport said. “Unfortunately, her physicians kept repeating the same mistake. They started each antidepressant at a low dose and only made minimal dose increases, if any. Each time Angela failed to derive any benefit from an antidepressant, rather than assertively increase the dose, her physicians instead switched her to an equally low dose of another antidepressant.”

Newport changed Angela’s antidepressant to one suitable for both her depression and anxiety, and gradually increased the dose until she experienced a remission of her depression and anxiety.

“Dr. Newport was confident it would work, and it has worked,” Angela said.

Since taking part in the Miller School program, Angela’s life has taken a significant turn for the better. She is scuba diving again, and playing an active role in her church, as well as talking to others about depression.

“People come up to me and ask what they can do,” she said. “I tell them it’s an illness just like cancer and it can be treated and cured, but you have to get the right treatment. I truly think my life would have been completely different if I had known about the Miami program 27 years ago.”

John Soloski, Ph.D., professor of journalism at the University of Georgia, contributed to this article. He serves on the External Advisory Board of the UM Miller School of Medicine’s Department of Psychiatry and Behavioral Sciences.

Tags: anxiety, Charles B. Nemeroff, depression, Jeffrey Newport, Miller School of Medicine, psychiatry, suicide, University of Miami, Women's Reproductive Mental Health Program