Depression: Implications for Treatment Decisions

More than 32 million adults in the United States will expe-rience depression in their lifetimes, and more than 13 mil-lion will endure its effects in any given year.1 Depression often co-occurs not only with other mental disorders such as anxiety and substance use1,2 but also with chronic physi-cal conditions, particularly in older patients.3 Because of the associated physical symptoms, patients often see pri-mary care physicians about both their physical and mental health symptoms.4 Therefore, primary care physicians are in a critical position to identify depression early in its course and to provide ongoing care to their patients presenting with depression symptomatology.5 However, many patients with signs and symptoms of depression who are seen by primary care physicians fre-quently leave the office undiagnosed and untreated for their depressive symptoms.4 Moreover, of those whose depression is recognized and treated by primary care physicians, many receive less than adequate treatment. For example, Cabana et al6 asserted that several studies have found that only 19% to 49 % of depressed primary care patients have received appropriate depression care according to the guidelines of the Agency for Healthcare Research and Quality, which are directed toward primary care physicians. In a study by Kessler et al,1 just 41.3 % of the respondents in general medi-cal treatment received adequate care; this figure included those who received care from a mental health specialist in addition to general medical care. Of those who received care from only a general medical practitioner, the treatment was considered adequate in merely 9.6 % of the cases.