What are the most effective diagnostic and therapeutic strategies for the management of depression in specialist care?

Summary

The issue

Depression is a major illness with health and social effects similar to those for chronic diseases like hypertension, congestive heart failure or diabetes. The Global Burden of Disease Programme of WHO indicates that depressive disorders are among the most important causes of death and disability in both developing and industrialized countries. However, there are wide variations in its prevalence and incidence among countries, perhaps partially due to different definitions, diagnostic measures and thresholds. In western Europe, major depression affects between 5% and 10% of the populations.

Findings

There are several well documented treatments for depression including drugs and psychotherapy. There is also evidence available of effective strategies to improve its management, especially about organizational and educational issues in primary health care. These include the incorporation of clinician education, nurse case management and a greater degree of integration between primary and specialist health care. Some of these strategies have been assessed in the United States, and their applications in Europe might be questionable. The potential benefit of screening for depression is still controversial.

Policy considerations

• There are well documented treatments for depression, mainly pharmaceuticals and psychotherapy.
• Collaboration across primary and speciality care including clinician education and nurse case management is of key importance in effective management of depression, enhancing its detection, recognition, diagnosis and treatment.
• Adherence to evidence-based guidelines improves treatment outcomes. Several established practices and prevailing opinions have been challenged by evidence-based medicine. Many of the recent systematic reviews and studies referred in this document should be consulted for developing guidelines and continued education.
• The importance of support in self-management, in particular for elderly people suffering from depression, is well documented in view of the fact that these individuals are particularly underserved.