Managing major depression: improving the interface between psychiatrists and primary care

Responsibility for identifying and managing most people with major depressi ve disorder (MDD) rests firmly within the primary care setting. Unfortunate ly, circumstances continue to have a negative impact on depression outcomes , with low recognition rates, inadequate levels of treatment and poor follo w-up all contributing to the provision of a less than optimal service for p atients. The Hampshire Depression Project confirmed that improved primary c are education, in isolation, does not have any long-term benefits for patie nts with MDD. However, many other studies have shown that stronger collabor ation between psychiatrists and primary care can significantly improve the quality of care provided in the primary care setting, and ensure that most patients are managed effectively and in accordance with international and n ational guidelines. Simple collaborative care models, which encourage menta l health specialists to work within the primary care system, have had a dra matic impact on the outcomes for patients, and significantly enhanced the s atisfaction of both patients and physicians with treatment. These intervent ions could easily and cost-effectively be applied more broadly and would en sure that effective management of MDD in primary care becomes the rule and not just the exception.