Strategies for effective management of depression in primary care. Based on a presentation by Michael S. Klinkman, MD.

The diagnosis and treatment of depressive disorders are challenges to the primary care physician because of the condition's high prevalence and chronicity, the frequent occurrence of medical and mental health comorbidities, patients' unwillingness to disclose a mental health history, and cost. Primary care physicians also cite lack of time and managed care policies as major barriers to improving outcomes in patients with depression. A potentially more effective approach to treating depression is health management, rather than traditional disease management. In this approach, the focus of care is patients' functional status and quality of life rather than the treatment of a specific health condition in isolation; patients are actively involved with care, and care choices are driven by competing demands. Another approach that may help improve outcomes in depression is the Recognize, Assess, Categorize, and Treat (ReACT) strategy, which is an efficient way to detect and triage patients with depressive disorders according to the severity of illness. Adjunctive aids, such as the use of support staff, monitoring systems, and collaborative care with mental health specialists, also have great potential for improving primary care physicians' effectiveness in treating depression.