Improving the treatment of depression in primary care: problems and prospects.

Previous work has succeeded in improving the recognition of depression by general practitioners. This is likely to be of most benefit when it results in effective treatment. Factors compromising the effectiveness of pharmacological treatments include non-compliance, non-response, and relapse of depression. Psychological therapies, such as cognitive therapy, are effective and may prevent relapse, but are not available to the majority of depressed patients seen in primary care. Existing evidence demonstrates that primary care staff can be trained in effective psychological interventions for depression, but interventions need to be developed which are sufficiently brief to be incorporated into routine treatment. Consistent provision of information about depression, coping strategies, and sources of support may improve compliance with treatment and subsequent outcome.