Time for a rethink of treatment for patients with depression in primary care

Abstract

The publication of a paper showing that mindfulness-based cognitive therapy prevented relapse of depression in a group of primary care patients at high risk of relapsing, is another reminder of the importance about these non-pharmacological therapies and should make us rethink what we are doing with treatment of depression in primary care.1 Cognitive therapy encourages patients to concentrate on their thinking patterns and become aware of their thoughts, so that they eventually introduce more helpful thoughts into their minds, while mindfulness refers to looking at our thoughts with increasing interest and acceptance. The current approach for many is to suggest a follow-up appointment within 2 weeks,2 and practitioners may have no system to check if this happens or not. Kay McKall in her wonderful article on ‘An Insider's Guide to Depression’ reminds us that patients with depression may not be thinking clearly and thus may not make a return visit, having neither the energy nor the inclination.3 A strategy for the alert practitioner is to book the next appointment while the patient is present, so that if they do not show up there is a reminder for the practitioner or team to contact them. ‘Active monitoring’ is an important part of current …