[Depression: longer-lasting episode not an automatic indication for referral]

During episodes of depression, patients exhibit a low mood and a number of other emotional and/or physical symptoms for a certain period of time. Regarding depression as just the defined episode when patients meet the criteria for diagnosis, ignores the fluctuating character of the illness and the role of the patient. The patient is, after all, the one who decides if and when the symptoms experienced are important enough to seek medical assistance. How a patient with depression should be treated, and whether or not and to whom the patient should be referred, depends on more than just the severity of the depression. This is because severity involves more than just the number of symptoms when the depression was first diagnosed. Ineffective coping behaviour and lack of social support both negatively influence the course of depression and if the initial treatment is not effective enough, the episode will be prolonged. The interest and skills of the general practitioners as well as the expectations and former experiences of the patient play a major role in deciding whether to refer a patient to secondary care.