A primary care perspective on management of acute and long-term depression

Major depressive disorder causing much social and physical dysfunction and risk of suicide is frequently seen in family practice, often presenting with somatic symptoms, sleep problems, or anxiety. Correct diagnosis allows prompt treatment with decreased morbidity and mortality. The new serotonin selective reuptake inhibitors (SSRIs), like fluoxetine, provide the family practitioner with antidepressants that are devoid of the unwanted and sometimes dangerous side effects of the older drugs. The SSRIs have a more benign side effect profile and are much safer in overdose. Patient education is essential regarding the medical nature of this disorder of the nervous system and its effective treatment with pharmacotherapy and need to continue full-dose maintenance therapy for 6 to 9 months after complete remission of the depressive episode to prevent relapse. Recognition of the recurrent nature of this illness is mandatory, and chronic (lifetime) full-dose prophylactic therapy is often necessary. The SSRIs assist in compliance to treatment.