title: A primary care focus on the diagnosis and treatment of major depressive disorder in adults.
abstract: Major depressive disorder (MDD), a highly prevalent psychiatric condition, is encountered in 1 of every 10 to 20 patients seen in the primary care setting. While awareness of MDD has increased, timely and accurate diagnosis and adequate treatment remain formidable challenges. Treatment options for patients with MDD should be individualized according to each patient's clinical and medication history, pharmacologic tolerability profile, and personal preferences, to maximize long-term adherence. The most robust and consistently maintained positive outcomes occur in patients who are administered effective treatment with recommended antidepressant pharmacotherapy, psychotherapy, or a combination of these treatment modalities. This manuscript reviews the epidemiology, biologic and clinical features, diagnosis, and treatment of patients with MDD. A focus is placed on guidelines and strategies that target the achievement of MDD symptom remission. The article also includes details on individualizing treatment selection and novel and emerging therapies. Primary care physicians must be prepared to adjust, substitute, or augment antidepressant treatments to optimize patient response and enhance the chances of achieving remission. Considerations that strongly influence long-term patient adherence, including tolerability and cost, are also reviewed.
authors.affiliation: Loyola University Stritch School of Medicine, Maywood, IL 60153, USA. ahalaris@lumc.edu
authors.forename: Angelos
authors.initials: A
authors.lastname: Halaris
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D014481:United States / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents