How Virtual Primary Care Supports Mental Health

March 21, 2022

Dr. Eric Bricker

Depression, anxiety and other mental health challenges are common and often go untreated in America. 18% of US adults have some form of mental illness — that’s almost 1 in 5 adults.1 Additionally, 57% of US adults with mental illness receive no treatment.2   

These statistics reveal that on average, 10% of an employer’s workforce has a mental illness that goes untreated. For example, a company with 1,000 employees has 100 employees with untreated mental illness. 

Medication therapy combined with counseling for depression and anxiety is an important treatment strategy for people suffering with these mental illnesses. 

Virtual primary care can provide medication therapy in many mental health situations.   

Diagnosis 

Diagnosis of depression, anxiety and other mental health conditions is performed through detailed history taking with a patient and using the Diagnostic Statistical Manual (DSM) criteria for diagnosis. 

Additionally, there is a screening questionnaire for depression called the Patient Healthcare Questionnaire (PHQ-9). It has 9 questions related to feelings, mood, thoughts and behaviors associated with depression.3 Patients are asked to rate how frequently these symptoms occur ranging from not at all to nearly every day over the past two weeks. 

Each answer is given a score and the total score is tallied. A score of 0-4 suggests the patient may not need depression treatment. A score of 5-14 is intermediate and a clinician should use their judgment to determine if treatment is warranted. A score of greater than 14 indicates a need for treatment with medication, counseling or a combination of these treatments. 

Virtual primary care can assess depression using DSM criteria and can administer the PHQ-9 questionnaire. 

Treatment 

Virtual primary care physicians can treat depression, anxiety and other mental health conditions with a variety of prescription medications that are safe and effective. 

  1. SSRIs – Selective Serotonin Reuptake Inhibitors 

Examples of these medications include fluoxetine (generic version of Prozac), sertraline (generic version of Zoloft), escitalopram (generic version of Lexapro). All these medications have been in use for a long time and cost less than $10 per month. 

2. SNRIs – Serotonin and Norepinephrine Reuptake Inhibitors 

Examples of these medications are venlafaxine (generic version of Effexor) and Duloxetine (generic version of Cymbalta). Similarly, these medications have been in use for a long time and cost less than $10 per month as well. There are additional classes of medications that can be used to treat depression beyond the medications mentioned above. 

A class of medications that is sometimes used to treat anxiety is called Benzodiazepines. Examples of prescription medications in this category include lorazepam (generic Ativan) and diazepam (generic Valium).  

Benzodiazepines are potentially addictive and considered controlled substances. Controlled substances have additional prescribing regulations due to their potential for becoming drugs of abuse. As such, First Stop Health’s prescription policy is to not prescribe any controlled substances and certain states even have laws against telemedicine providers prescribing controlled substances. 

Counseling 

Many people benefit from counseling instead of or in addition to medication treatment for their depression, anxiety or other mental health condition. That counseling could be from an in-person therapist or a virtual therapist — like the ones First Stop Health offers through our Virtual Mental Health solution. 

One of the most familiar challenges for patients today is accessing counseling services. Many counselors do not take insurance or do not have appointment availability for weeks to months in the future. The stresses and isolation of the pandemic have created a greater demand for counseling services, but fortunately many counselors and virtual mental health services offer virtual visits as a carved-out, stand-alone benefit for employers and their plan members. 

Integration with Physical Health 

Mental health and physical health are intricately interwoven — which is why it is so common and beneficial for primary care physicians to treat mental health conditions alongside physical conditions such as diabetes and hypertension. 

For example, if a patient has depression AND diabetes, it is extremely hard for that person to take care of themselves, eat right, exercise and take their diabetes medication correctly. As a result, their diabetes worsens. However, virtual primary care physicians can treat a patient’s depression and in doing so, improve the patient’s adherence to the lifestyle and medication regimen needed to control their diabetes. 

Virtual primary care is an innovative approach to the diagnosis and treatment of mental health conditions. It dramatically improves access to care by eliminating the need for travel time and expense and can frequently be offered at $0 out-of-pocket cost. Virtual primary care allows employees who had previously been marginalized by the traditional healthcare system to get the help they need — mentally and physically. 

Sources:  

1 https://www.aafp.org/fpm/2017/0700/p11.html 

2 https://www.mhanational.org/issues/2021/mental-health-america-access-care-data 

3 https://www.mdcalc.com/phq-9-patient-health-questionnaire-9 

Originally published Mar 21, 2022 1:00:00 PM.