Improving care for depression

New approaches to managing a chronic illness

Patients with depression are much more likely to receive effective treatment today than in the 1990s, but the results often fall short of what most patients want and deserve — full relief. The length of depressive episodes and the risk of recurrence have changed too little. Most people who seek help for depression rely exclusively on primary care medicine — family doctors, who are generalists. They are usually the gatekeepers even for patients who eventually use specialized mental health services for psychotherapy or antidepressant prescriptions. So non-psychiatric physicians, mental health professionals, insurers, and HMOs have been looking for ways to improve the detection, diagnosis, and treatment of depression in primary care.

Surveys suggest that there is plenty of room for improvement. A third to a half of depressed patients who see a primary care physician are not accurately diagnosed, and even when depression is identified, it is often inadequately treated. Patients do not get a sufficient dose of antidepressants for a sufficient time, do not return for follow-up visits often enough, and usually receive no psychotherapy at all.