Awareness, diagnosis, and treatment of depression

OBJECTIVES: To review recent findings on the epidemiology, burden, diagnosi s, comorbidity, and treatment of depression, particularly in general medica l settings: to delineate barriers to the recognition, diagnosis, and optima l management of depression in general medical settings; and to summarize ef forts under way to reduce some of these barriers. DESIGN: MEDLINE searches were conducted to identify scientific articles pub lished during the previous 10 years addressing depression in general medica l settings and epidemiology, cc-occurring conditions, diagnosis. costs, out comes, and treatment. Articles relevant to the objective were selected and summarized. CONCLUSIONS: Depression occurs commonly, causing suffering, functional impa irment, increased risk of suicide, added health care costs, and productivit y losses. Effective treatments are available both when depression occurs al one and when it co-occurs with general medical illnesses. Many cases of dep ression seen in general medical settings are suitable for treatment within those settings. About half of all cases of depression in primary care setti ngs are recognized, although subsequent treatments often fall short of exis ting practice guidelines, When treatments of documented efficacy are used, short-term patient outcomes are generally good. Barriers to diagnosing and treating depression include stigma; patient somatization and denial; physic ian knowledge and skill deficits; limited time: lack of availability of pro viders and treatments; limitations of third-party coverage; and restriction s on specialist, drug, and psychotherapeutic care. Public and professional education efforts, destigmatization, and improvement in access to mental he alth care are all needed to reduce these barriers.