Spotting the Subtle Signs of Depression: How Familiarity Helps Family Physicians Excel, With Teresa Lovins, MD
Primary care clinicians see a higher share of visits for depression than mental health professionals largely because they know their patients so well, Lovins said.
Primary care clinicians see a higher share of visits for depression than mental health professionals, according to the current literature,1,2 and there are several reasons. Access to psychiatrists is limited in many areas due to shortages, long wait times, and insurance restrictions, so patients often turn to their primary care clinician, generally a health care professional they already know and can see quickly, for help with mood symptoms or mental health concerns.1,2
Given the lingering stigma attached to seeing a mental health specialist, individuals are likely to feel more comfortable being honest with a familiar clinician.2,3 Symptoms of anxiety or depression quite often present as physical complaints, eg, fatigue, pain, or sleep problems, that will bring someone to their family doctor, where a broader concern can be uncovered.4
Teresa Lovins, MD, a family physician and owner of Lovin My Health DPC, in Columbus, Indiana, concurs with these observations. In a recent interview with Patient Care,© she echoed the fact that family physicians are uniquely positioned to detect changes in patients’ mood or behavior because they know their patients well: “Do they present themselves in a different way? Are they anxious? Are they withdrawn? Are they having mood swings?” she said. The differences may be subtle but family and other primary care clinicians are trained to observe for nonspecific symptoms that may be traceable to an underlying issue, Lovins added. In the family practice setting, a family member may even accompany a patient and explain that "they're just not acting the way that they normally do."
In the short video above, Lovins describes the presenting symptoms that are telltales of a deeper issue for her and reiterates the value of the long-term primary care relationship.
The following transcript has been lightly edited for style and flow.
Patient Care: What are some of the key warning signs or risk factors for potential suicidal thinking that clinicians should be alert for?
Teresa Lovins, MD: First and foremost, as a family physician, you get to know your patients and so, do they present themselves in a different way? Are they anxious? Are they withdrawn? Are they having mood swings? All of those things lead us to think that there's something in their mental health that could be addressed. And so we look for those negative things that go along with suicidal risk, including what might be "out there" that could potentially hurt them. Are they doing things that are risky for their lives? Are they driving at 100 miles an hour? Sometimes it's even their family members who come in with them and who identify that they're just not acting the way that they normally do. They're starting to withdraw from the interactions that they have in their household. So, it's a it's a matter of looking for nonspecific symptoms and then readdressing those back to why that's happening for them.
If you or someone you know is struggling with mental health, please reach out for help. There are many resources available to provide support and guidance. National Hotlines: 988 Suicide and Crisis Lifeline: A 24/7 hotline for immediate support; NAMI HelpLine:1-800-950-NAMI (6264); Crisis Text Line: Text HOME to 74174
References
Stene-Larsen K, Reneflot A. Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scand J Public Health. 2019;47(1):9-17. doi: 10.1177/1403494817746274
Weiner S. A growing psychiatrist shortage and enormous demand for mental health services. Association of American Medical Colleges. August 9, 2022. Accessed August 29, 2025. https://www.aamc.org/news/growing-psychiatrist-shortage-enormous-demand-mental-health-services
Walby FA, Myhre MØ, Kildahl AT. Contact with mental health services prior to suicide. a systematic review and meta-analysis. Psychiatr Serv. 2018;69(7):751-759. doi: 10.1176/appi.ps.201700475
Harmer B, Rizvi A, Saadabadi. Suicidal ideation. StatPearls [internet]. National Center for Biotechnology Information. Updated April 20, 2024. Accessed August 29, 2025. https://www.ncbi.nlm.nih.gov/books/NBK565877/
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