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Cited by 19Mental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTreatment of Major Depression

Depression in primary care: three key challenges

Lester, H, Howe, A·2008·Postgraduate Medical Journal
DOI 10.1136/pgmj.2008.068387
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Abstract

The recognition and treatment of depression is a challenging area of clinical practice, especially in primary care where there are many patients with various presentations and a multitude of causes for distress. The prevalence of depression is increasing, and it is predicted to become second only to ischaemic heart disease as a cause of morbidity worldwide. Fortunately, the research evidence on effective approaches is increasing. This article looks at how we can best identify, treat and understand the perspectives of people with depression who are seen in primary care. Simple questionnaires can provide effective screening in generalist settings, particularly when targeting high-risk groups such as those with cardiovascular comorbidity or recurrent unexplained symptoms. Guidelines now exist for use of antidepressants and cognitive behavioural therapy for mild to moderate depression, although the latter needs effective policy implementation in clinical practice to maximise its impact for patients. However, there is also consistent evidence from service users that people with depression want individualised care which takes into account their preferences and concerns, even if this entails departure from guidelines. Adherence to treatment is low in many studies, and remodelling of services can easily lead to gaps in consistent approaches to personal care. The research challenges for the future include clarification of which patient groups merit proactive screening, how to enhance adherence, and the relative merits and outcomes of pharmacological versus behavioural therapies. Changes in policy and service configuration can improve or destabilise effective care, but high-quality and flexible intervention with patients with mild to moderate depression is likely to be cost-effective in view of the high prevalence and disease burden of this distressing problem.

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Authors
Lester, H., & Howe, A.
Affiliations
  • University of Manchester (GB)
  • University of East Anglia (GB)
Corresponding author
Howe, A
ORCID
Howe, A
Venue
Postgraduate Medical Journal
Publisher
Oxford University Press (OUP)
Published
2008-10-01
Volume
84
Issue
996
Pages
545-548
ISSN
  • 0032-5473 (ISSN-L)
  • 1469-0756
DOI
10.1136/pgmj.2008.068387
OpenAlex
W2167083036
Cited by
19
References
38
Citations by year
2019: 4 · 2016: 2 · 2015: 3 · 2014: 2 · 2013: 1 · 2012: 2
FWCI
2.22
Type
journal article
Language
en
Open access
closed
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • Postgraduate Medical Journal (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
depression, primary care, depression screening, antidepressants, cognitive behavioral therapy, medication adherence, patient preferences, service user perspectives, cardiovascular comorbidity, service gaps, cost-effectiveness, mild to moderate depression
MeSH terms
Antidepressive Agents, Chronic Disease, Depressive Disorder, Family Practice, United Kingdom, Humans, Medical History Taking, Primary Health Care, Cognitive Behavioral Therapy, Practice Guidelines as Topic

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