Barriers to diagnosis, advances in therapy

Depression is underdiagnosed in primary care because of several factors, including variances in the clinical presentation of depressive symptoms, as well as comorbid medical, psychiatric, and substance abuse problems. Time constraints imposed by managed care add to the challenge of diagnosis. The current medical system encourages a reliance on somatic symptoms for accurate diagnosis, and tools that measure somatic symptoms, such as the Primary Care Rapid Assessment Scale, may be useful. After diagnosis, the depressed patient may benefit from one of the many new antidepressant modes of therapy and medications in the pipeline. Psychotherapeutic treatment modalities should also be taken into account. These diagnostic and therapeutic options are rapidly becoming available to primary care physicians, who should use them to achieve long-term remission of depressive symptoms.