Depression in Primary Care

Abstract

Ten to 25% of patients assisted in general outpatient care centers suffer from depression1. Although frequently ignored or underdiagnosed, depression is the second most frequent cause of consultations. In most cases, patients with symptoms of depression are assisted by general practitioners instead of psychiatrists2. Depression occupies the second place among the most disabling diseases in the western countries3. In most developing countries, mental healthcare is still unacceptably deficient, and one of the goals of the WHO is improving diagnosis and management of depression in general outpatient care centers all over the world. Several strategies prove cost-effective, mainly: continued medical education, more participation of the nursing personnel and better integration between primary and secondary care (psychiatrist)4. As demonstrated by metaanalytical studies, in the management of light or moderate depression there is little difference in efficiency between different treatment modalities and antidepressants. The most important factor is continuity of the treatment. The best results are achieved when there is therapeutic alliance between doctor and patient and when an adequate treatment is kept on for sufficient time5. This study discusses the importance, diagnosis and treatment of depression in primary care and proposes strategies for implementing a care network articulated with secondary care.