Depressed patients who do and do not receive psychiatric consultation in general hospitals

A chart review was conducted of depressed patients at three general hospitals without psychiatric units. A substantial proportion of the patients did not receive psychiatric consultation. These patients tended to be less seriously ill than those who were evaluated by consulting psychiatrists. Despite the fact that a majority of patients treated without consultation reported disturbances of mood, appetite, and sleep, as well as somatic pain for which no source was readily apparent, only a small proportion received antidepressants in standard dosages. Issues surrounding the indications for and attitudinal barriers to antidepressant use in primary care are discussed.