Identifying and managing depression in primary care in the United kingdom

The Depression Guideline Panel for the National Institute for Clinical Excellence (NICE) in England has developed a stepped-care model for the recognition and treatment of depression in primary care. The first 3 steps of the model apply to primary care settings and were developed to help primary care professionals overcome barriers to recognizing depression. The somatic symptoms of depression present the most significant barrier to recognition because patients who somatize their symptoms will often lead their physician to think there is a physical reason for the symptoms. This preoccupation with physical illness often delays or prevents diagnosis. Step 1 of the care model focuses on recognizing depression by initially assessing patient mood and interest. Step 2 suggests nonpharmacologic therapies for patients who have mild depression, and step 3 suggests pharmacologic and nonpharmacologic therapies for patients who have moderate-to-severe depression. Improving awareness of the symptoms of depression and physician core skills through guideline-driven practice will hopefully increase the recognition rates for depression in England.