Depression and practice guidelines

Over the past two decades there have been great advances in the understandi ng of depression and in the development of pharmacological agents and psych osocial treatments that have demonstrated efficacy in the treatment of this common and disabling illness. Unfortunately, this knowledge and evidence i s not consistently translated into actual treatment, and depression remains undiagnosed in a large percentage of patients, and when it is accurately d iagnosed, it often is suboptimally treated. The frequent failure to properly diagnose depression may be due to the cont inuing stigma of mental illness, the persistence of the biomedical, rather than the biopsychosocial, paradigm of illness and treatment, educational is sues and the time constraints in the typical medical practice. The suboptim al treatment may be due to all of these issues plus the difficulty in chang ing physician behaviours even when there: exists much evidence that would s eem to dictate such a change. The development of a criteria-based nomenclat ure and the subsequent development and dissemination of evidence-based prac tice guidelines addresses some of these issues. Copyright (C) 2001 John Wil ey & Sons, Ltd.