Major depressive disorder, mental health care, and the use of guidelines in the Middle East.

A large gap exists between the number of people needing treatment and the number of people receiving treatment for depression in the Middle East. Barriers to mental health care in the region have included the lack of education for primary health care providers about mental illnesses, the scarcity of trained mental health care specialists, the lack of resources in developing countries, and the stigmatization of mental illness in Middle Eastern cultures. Guidelines for the treatment of depression have not been developed in most countries of the region. Guidelines have been published for both general practitioners and for psychiatrists in Turkey, and they are similar to guidelines published in the West. These guidelines are assessed using the AGREE instrument. Although guidelines recommend antidepressants as a first-line treatment for depression, many physicians in Middle Eastern countries prescribe benzodiazepines. One reason for this treatment gap may be that patients with depression often seek treatment from primary care providers and report somatic symptoms. Primary care providers may not be as knowledgeable about the diagnosis of depression or its treatment as psychiatrists and may not have access to certain classes of medications. More education for both physicians and patients in the Middle East is needed to decrease the stigma associated with depression.