New Approaches to Managing Depression

Most people who seek help for depression first visit their primary care doctors. So these professionals, along with mental health professionals and insurers, have been looking for ways to better identify and treat depression in the primary care setting, reports the September issue of the Harvard Mental Health Letter.

Depressed patients are often reluctant to bring up the subject with their doctors, so a short but valid screening test could help with detection and diagnosis. The Mental Health Letter says doctors might start by asking patients two questions: Over the past two weeks, have you felt down, depressed, or hopeless? Over the past two weeks, have you felt little interest or pleasure in doing what you normally do? Studies suggest that almost every patient who needs treatment for depression will answer yes to at least one of these questions.

Other new approaches focus on managing the treatment of depressed patients. In one program, for example, a depression care manager provided telephone checkups and a relapse prevention plan, and patients were referred to a psychiatrist if they did not improve. Nearly half of patients in the program showed a reduction of at least 50% in depressive symptoms, compared with 19% in usual care, and differences persisted even a year after the program ended.

Two general reviews covering dozens of studies have found that depressed patients in management programs are more likely to comply with treatment and more satisfied with the results. "Thankfully, attitudes toward depression have improved over the last 20 years, which has opened up the possibility for wider use of care management systems," says Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter.

Also in this issue:
• Solution-focused therapy
• Intermittent explosive disorder
• The genetics of autism
• Drug addiction and death
• Alzheimer's disease and the placebo response
• A doctor discusses: Men and anorexia

Harvard Mental Health Letter