Mild depression in general practice: time for a rethink?

Clinical studies, conducted chiefly in hospital settings, have demonstrated that antidepressant drug therapy is effective treatment for major depressive disorder of at least moderate severity, and that cognitive therapy is an effective alternative to antidepressants in mild to moderate major depression. However, few clinical trials have taken place in general practice, where the great majority of patients with depression are managed. Most such patients in this setting do not meet diagnostic criteria for major depression, and are often described more loosely as having 'mild depression'. Many are given an antidepressant, often as the first step in treatment. Here, we consider whether this is the optimal approach for adults with mild depression in general practice.