Depression and primary care: drowning in the mainstream or left on the banks?
OBJECTIVE
To discuss the treatment, barriers, and successful strategies to treat depression in a primary care setting.


CONCLUSIONS
Historical, conceptual, and individual barriers hinder the treatment of depression. Additionally, a lack of clarity about whether the responsibility for care lies with primary care or behavioral health providers further leads to fragmented and uncoordinated systems. Depression is a chronic illness, not unlike diabetes, heart failure, and asthma. Therefore, disease models used to treat these chronic illnesses can also be applied to successfully treat depression.


CONCLUSIONS
Appropriately managing patients with depression and other behavioral health conditions will require changing the entire health care system. Future strategies should include developing a continual quality improvement process, developing bridges between behavioral health and primary care, eliminating clinical and financial barriers between systems, and viewing the mind and body as a whole.
Pincus
Harold Alan
HA
Western Psychiatric Institute and Clinic, 3811 O'Hara St., Suite 230, Pittsburgh, PA 15213, USA. pincusha@upmc.edu
D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D020399:Practice Management; D011320:Primary Health Care; D014481:United States / Q000453:epidemiology