No abstract

Pharmacotherapy and psychotherapy effectively treat major depression among primary care patients when provided within specific parameters and for the full acute and continuation phases. Treatment principles recommended by the Depression Guideline Panel of the Agency for Health Care Policy and Research are supported.

No abstract

Individuals suffering from depression seek help as frequently in the primary care setting as in psychiatric facilities. As primary care physicians increasingly provide such treatments, they will need to assess a patient's clinical status before, during, and after treatment. The authors evaluated the concordance and factor structures of 2 widely used depression inventories, the Beck Depression Inventory and the Hamilton Rating Scale for Depression, in a sample of primary care patients participating in a randomized, control trial of treatments for major depression. The 2 scales were significantly correlated and assessed similar rates of improvement at multiple assessment points. Factor analyses indicated that despite their equivalent assessment of severity of depression, the 2 instruments emphasize different dimensions of depression.

Primary care patients with major depressive disorder report substantial impairments in physical, psychological, and social functioning on initial assessment. Severity of baseline medical comorbidity did not correlate with severity of depression and only weakly correlated with functional status at 8 months. Functional impairments improve with time, but standardized depression-specific treatment is associated with greater improvement in more domains of functioning than is a physician's usual care.