ON THE AHCPR DEPRESSION IN PRIMARY-CARE GUIDELINES - FURTHER CONSIDERATIONS FOR PRACTITIONERS

The majority of cases of clinical depression go unrecognized and untre ated, despite the fact that depression is an eminently treatable disor der. The Agency for Health Care Policy and Research (AHCPR) recently p ublished a set of clinical practice guidelines focused on depression i n primary care settings. The review of the literature on which the gui delines are based is thorough and appropriate and should enhance the d etection of depression and the quality of pharmacotherapy for depressi on. However, the guidelines encourage primary care physicians to provi de pharmacotherapy To their depressed patients as the first line of tr eatment. The wisdom of this recommendation is questioned and revisions to the guidelines are suggested. Specifically, patients should be inf ormed of the broad array of treatment options available and provided w ith a more balanced presentation of the potential benefits of psychoth erapy for depression. Patients should decide which treatment alternati ve they wish to undergo.