Managing major depression: improving the interface between psychiatrists and primary care.

Responsibility for identifying and managing most people with major depressive disorder (MDD) rests firmly within the primary care setting. Unfortunately, circumstances continue to have a negative impact on depression outcomes, with low recognition rates, inadequate levels of treatment and poor follow-up all contributing to the provision of a less than optimal service for patients. The Hampshire Depression Project confirmed that improved primary care education, in isolation, does not have any long-term benefits for patients with MDD. However, many other studies have shown that stronger collaboration between psychiatrists and primary care can significantly improve the quality of care provided in the primary care setting, and ensure that most patients are managed effectively and in accordance with international and national guidelines. Simple collaborative care models, which encourage mental health specialists to work within the primary care system, have had a dramatic impact on the outcomes for patients, and significantly enhanced the satisfaction of both patients and physicians with treatment. These interventions could easily and cost-effectively be applied more broadly and would ensure that effective management of MDD in primary care becomes the rule and not just the exception. ( Int J Psych Clin Pract 2001; 5 (Suppl 1): S11-S18).