Depression in primary care: evolving concepts and approach to therapy

Depression is one of the most commonly encountered maladies in clinical practice. Most depressed patients are seen first by nonpsychiatrist physicians who frequently overlook or ignore the depression. Many depressed patients can and should be treated by primary care physicians if those physicians are aware of diagnostic and management principles. These principles include knowledge of the clinically useful classifications, the wide variety of typical and atypical manifestations, the medical illnesses associated with depression, the neuroendocrinologic manifestations of major depression, and the use of aggressive, effective therapy. With those tools, the physician can effectively intervene in the course of an illness that affects a large portion of the population and causes considerable psychologic and physical anguish.