Lemperiere T, Ades J
Encephale. 1979;5(5 Suppl):483-90.
Given the high incidence of depression, it is necessary and desirable that as many cases as possible should be treated by general practitioners. However, general practitioners are on the whole ill-prepared to meet the needs of depressed patients. In the last few years a big effort has been made in certain countries to improve the psychiatric training of general practitioner and to enable him the better to detect and treat depression. Communication between psychiatrists and general practitioners is made difficult by the lack of a common language and terms used should be defined clearly. Some of the problems in practice are diagnostic in nature: detect of the depressive syndrome, of the minor or masked forms; differential diagnosis of depression and anxiety. The commonest problems in treatment are: selection of drug, monitoring of side-effects, duration of treatment. The general practitioner needs information also on such questions as: how to evaluate the risk of suicide; when to call in the specialist; how far to use supportive psychotherapy. Some types of depression are particularly likely to come to the general practitioner: depression masked by physical symptoms, depression associated with or secondary to physical disease, depression in the elderly.
鉴于抑郁症的高发病率，尽可能多的病例由全科医生治疗是必要且可取的。然而，总体而言，全科医生并未做好满足抑郁症患者需求的准备。在过去几年里，某些国家付出了巨大努力来改善全科医生的精神科培训，使其能够更好地检测和治疗抑郁症。精神科医生和全科医生之间的沟通因缺乏共同语言而变得困难，所使用的术语应明确界定。实践中的一些问题本质上是诊断性的：检测抑郁综合征、轻微或隐匿形式；抑郁症与焦虑症的鉴别诊断。治疗中最常见的问题是：药物选择、副作用监测、治疗持续时间。全科医生还需要有关以下问题的信息：如何评估自杀风险；何时请专科医生会诊；在多大程度上使用支持性心理治疗。某些类型的抑郁症特别容易出现在全科医生那里：由身体症状掩盖的抑郁症、与身体疾病相关或继发于身体疾病的抑郁症、老年人的抑郁症。
