Improving practice – Major depressive disorder
Dr George Kassianos
General Practitioner, Berkshire, UK
Depression is a highly prevalent condition, with the majority of patients diagnosed and managed in primary care. Despite the fact that depression is so common, many patients are still not appropriately identified when they first present in primary care. Moreover, some patients do not even visit their doctor because of the stigma that is still associated with the condition. This under-recognition is principally a function of the complexity of the condition, as depression usually presents as a constellation of signs and symptoms, compounded further by the fact that patients often feel helpless in their ability to communicate how they feel. Such factors make diagnosing depression particularly challenging in the primary care setting. Good interviewing skills lie at the heart of establishing a correct diagnosis. As GPs we can also motivate our patients to persist with the treatments we prescribe by establishing ‘contracts’ with them. By providing quality education and reaffirming the fact that neurochemical imbalances are central to the development of mood disorders such as depression, we stand more of a chance of improving adherence and achieving positive outcomes with one of the wide array of effective treatments that are currently available to treat major depressive disorder (MDD).