Managing depression in primary care: it's not only what you do it's the way that you do it

Abstract

Common mental health problems place significant demands on primary care services both in terms of time and resources.1,2 Of the common mental health problems, depression and anxiety make up about 97%.3 Depression is costly to the individual, their family and community, and represents a significant loss of human capital. It poses a considerable burden to the national economy4 and people with depression represent the largest single group receiving incapacity benefits.5,6 Depression is often chronic, has high relapse rates, increases the likelihood of suicide, and is associated with an increased risk of many physical disorders.7 It continues to present a major public health challenge8 despite public education campaigns and evidence-based treatment.9,10 Four papers in this month's BJGP highlight some of the potential problems of treating patients with depression. Patients frequently do not take antidepressant medication as prescribed with as few as 10% of patients completing a course of treatment.11 Van Geffen et al , in this issue of the BJGP , explore the rates of commencing treatment in patients prescribed antidepressants.12 They found that 28% of people newly prescribed an antidepressant by their GP never cashed in their prescriptions or only did so on one occasion. This failure to take the prescribed antidepressants was higher in people given antidepressants for non-specific indications, such as sleep problems, fatigue, relationship problems, and in non-Western immigrants and older people. This compares to drop-out rates for psychological therapies of about 30%7 and poses a particular challenge for healthcare professionals. Antidepressant prescribing has risen in many countries over recent years. Morrison et al , in this issue of the journal, surveyed antidepressant prescribing in Scotland, and found wide prescribing variations.13 These variations showed a positive association with morbidity levels, …