Therapeutic consultations for patients with depressive symptoms.

Abstract

This article discusses the state of our current knowledge about how GP consultations might be therapeutic for patients with depressive symptoms. This is important for two reasons: the GP consultation is the most common medical intervention for depressive symptoms in Western societies; and there is substantial uncertainty about the efficacy of the second most common medical intervention, the prescription antidepressant medication.1 Paul Little and colleagues have shown that a positive, patient-centred approach by GPs to the generic primary care consultation is associated with greater patient satisfaction and enablement, and also appears to reduce symptom burden and referral rates.2 Components of such an approach are: a sympathetic doctor who is interested in the patient’s worries and expectations; who discusses and agrees the problem and treatment; who knows the patient and their emotional needs; who is definite about the problem and when it will settle; and who expresses interest in the effect of the problem on the patient’s life. In consultations concerned specifically with depression, over and above any pharmacological effect of antidepressant medication, therapeutic benefit is derived if the GP conveys a sense of hope and optimism, and establishes a positive relationship with the patient.3 Better outcome is also associated with the GP being rated, by patients or observers, as being skilful in providing empathy and support.4,5 Let us accept that expressing warmth and attention, exploring the patient’s concerns and expectations, and expressing interest in the effect of the problem on the patient’s life are all highly likely to be intrinsically therapeutic. Let us also accept, with two caveats, that a personal relationship, where the …