[Improving the management of depression in primary care: review and prospects]

Depression is a common disorder, associated with significant social and functional impairment, and whose natural course tends to chronicity. The majority of the patients suffering from this disorder are attended in primary health care settings. General practitioners represent the greatest part of the prescribers of antidepressants. Unfortunately, there are many barriers with detection and with the treatment of depression, thus only a minority of patients profits from a treatment with effective posology and with sufficient duration.

Several programs of interventions directed by mental health professionals aim at improving the management of depression in primary care. There are single interventions consisting of an educational program to physicians or a single intervention to the patient. The assessments of an educational strategy find some contradictory results. Single interventions are not sufficient by themselves. On the other hand, programs associating several interventions are effective. These associations consist of an educational intervention to the physicians and an intervention or more to the patient treated by antidepressant. Interventions are generally carried out by nurses and supervised by a psychiatrist. Mental health professionals share their informations with general practitioners. Interventions can be telephone or in <>. Telephone interventions have the advantage of a low cost and appear quite as relevant as interventions in <>.

But the effectiveness of these programs grows blurred in time, unless the program itself does continue. Moreover, this effectiveness is variable according to the severity of symptomatology. Indeed, the interest of this type of programs for the patients suffering from minor depression is limited. These various programs can be supplemented by the contribution of tools of detection or assessment of the depressive symptomatology to general practitioners, like by the contribution of oral and/or written informations to the patient concerning the disorder from which he suffers. The setting-up of such programs represents a considerable cost but depression is itself responsible for an important cost for our society. Several estimates concerning the setting-up of these programs find a good cost-effectiveness ratio; it should facilitate their installation taking into account their effectiveness.

A close cooperation, based on the complementarity between general practitioners and mental health professionals is required to improve the management of depression.