Center for Family and Community Medicine, Columbia University Medical Center, New York, NY, USA.
Royal National Orthopaedic Hospital.
BMJ. 2019 Apr 8;365:l835. doi: 10.1136/bmj.l835.
Depression is a common and heterogeneous condition with a chronic and recurrent natural course that is frequently seen in the primary care setting. Primary care providers play a central role in managing depression and concurrent physical comorbidities, and they face challenges in diagnosing and treating the condition. In this two part series, we review the evidence available to help to guide primary care providers and practices to recognize and manage depression. The first review outlined an approach to screening and diagnosing depression in primary care. This second review presents an evidence based approach to the treatment of depression in primary care, detailing the recommended lifestyle, drug, and psychological interventions at the individual level. It also highlights strategies that are being adopted at an organizational level to manage depression more effectively in primary care.
抑郁症是一种常见且异质性的疾病,具有慢性和复发性的自然病程,在初级保健环境中经常见到。初级保健提供者在管理抑郁症和并发的躯体共病方面发挥着核心作用,但他们在诊断和治疗这种疾病方面面临挑战。在这两部分系列中,我们回顾了现有证据,以帮助指导初级保健提供者和实践,以识别和管理抑郁症。第一篇综述概述了在初级保健中筛查和诊断抑郁症的方法。第二篇综述介绍了在初级保健中治疗抑郁症的循证方法,详细介绍了个体层面推荐的生活方式、药物和心理干预措施。它还强调了在组织层面上为更有效地管理初级保健中的抑郁症而采取的策略。