Behavioral interventions for office-based care: depressive disorders

Depressive disorders commonly are diagnosed and managed in primary care settings, and many patients prefer a nonpharmacologic approach. Traditionally, symptom reduction through pharmacotherapy has been the primary focus of management, but there is a growing acknowledgment of the need to develop modalities that prevent subsequent relapse and recurrences. Psychotherapy, including cognitive behavioral and interpersonal therapies, can have enduring effects that reduce subsequent risk in ways that drugs cannot. Although most family physicians do not provide formal psychosocial interventions for depression, brief interventions and behavioral intervention technologies, such as those that deliver care via the Internet or mobile device, are key means of increasing access to psychotherapy. For children and adolescents with mild, uncomplicated depression, physician-provided social support, encouragement, and reinforcement of adaptive behavior patterns can be as effective as cognitive behavioral therapy. In addition, a primary care physician's involvement in parent education and safety planning for suicide prevention holds promise for risk reduction. Evidence also supports the use of problem-solving therapy and components of cognitive behavioral therapy and interpersonal psychotherapy provided by primary care physicians for patients with depression.