American health care systems and depression: The past, present, and the future

American medicine has witnessed 3 major periods in this century that have a ll played key roles in the evolution of today's medical systems, practice, and education. The first of these periods followed the publication of the F lexner report in the early 1900s that was critical of the then current medi cal education system. The second came with the development of specialties i n the 1920s and 1930s, and the third with the growth of HMOs and managed ca re and with the reemergence of primary care. Mental health practice has als o evolved, moving from a specialist-based direct access to a primary care m odel. Although great strides have been made regarding the treatment of depr ession, an overwhelming majority of patients are still undertreated. Treatm ents for the future must focus on programs to improve recognition of depres sion, reduce stigma, and increase compliance.