Special clinics are inappropriate for treating depression

doi:10.1136/bmj.321.7254.178

BMJ 2000;321:178 ( 15 July )

Letters

Special clinics are inappropriate for treating depression

The first 150 words of the full text of this article appear below.

EDITOR $---$ Kendrick proposes introducing special clinics for the management of depression in general practice because depressionis a chronic remitting condition.¹ He draws analogies withother chronic conditions such as diabetes and asthma, where careis often provided in clinics devoted to the management of thespecific condition. His argument is flawed on severalcounts.

Firstly, diabetes and asthma are relatively homogeneous physical illnesses for which there are acceptable treatments, objectivemeasures of control, defined management targets, and some knowledgeof long term sequelae if the illness is poorly managed. In contrast,the psychopathology of depression is less well understood; thecondition, particularly in general practice, is heterogeneous;and less is known about the long term outcomes. Thus, the analogyis simplistic and relies on the inappropriate application of areductionist medicalmodel.

Secondly, the diagnosis of depression does not merely involve the recognition of symptoms and clinical signs . . . [Full text of this article]