Managing depression in primary care

Public confidence needs to be restored after concerns over the safety of SSRIs

Depression is a condition of “particular concern, which costs lives and affects the quality of life,” according to UK prime minister Tony Blair.1 Nine out of 10 depressed patients are treated only in primary care,2 3 and up to two thirds of suicide victims contact a general practitioner in the four weeks before the death.4 For years, however, general practitioners have been criticised for failing to deal adequately with depression. Like hypertension, depression is subject to a rule of halves—only half of depressed patients seek help from doctors, half are detected in primary care, half receive treatment with only half completing it: fewer than 10% finish a therapeutic course of treatment.5 A range of initiatives, often erroneously based on educational models for general practitioners, has aimed to improve detection rates and to increase the appropriateness of prescribing in depression with variable success, including a spectacular failure, in Hampshire, to influence general practitioners' behaviour at all.6

There are many reasons why depression goes unrecognised in primary care. …