Major depressive disorder (MDD) from the patient's perspective: overcoming barriers to appropriate care.

Major depressive disorder is a highly stigmatized condition which, despite its prevalence in primary care, is broadly unrecognized and consistently poorly treated. Epidemiological studies reveal a disconcerting lack of understanding about depression within the general population, and this invariably affects patients' attitudes to treatment. Public opinion polls have found a widespread distrust of antidepressant medications, and most members of the public would prefer a psychosocial or alternative approach to treatment to a pharmacological one. Public awareness initiatives such as the UK's Defeat Depression Campaign have helped to positively shift public attitudes towards depression and its treatment, but misconceptions about antidepressant medications appear especially entrenched. The landmark DEPRES study found that over 40% of patients did not consult their doctors for their depression, and only 30% of consulters received an antidepressant. Six clearly differentiated patient clusters were also identified in this study, suggesting that treatment might be selected on the basis of individual symptom profiles and other key differentiating factors. By understanding our patients' perspectives on depression and its management, it should be possible to improve rates of consultation and overcome resistance to antidepressant treatment. Only by achieving both of these goals in parallel will we really be making progress towards optimal management of major depression. ( Int J Psych Clin Pract 2001; 5 (Suppl 1): S37-S42).