BMJ 2008;336:435-439 (23 February), doi:10.1136/bmj.39478.609097.BE
Clinical Review
Management of depression in adults
Markku Timonen, professor of general practice1,
Timo Liukkonen, senior consultant2
1 Institute of Health Sciences, University of Oulu, Box 5000, FIN-90014, Finland,
2 Department of Psychiatry, Savonlinna Central Hospital, Finland
Correspondence to: M Timonen markku.timonen@oulu.fi
| The first 150 words of the full text of this article appear below. |
A study by the World Health Organization ranked depression the fourth global burden of disease and found it to be the largest non-fatal burden of disease, with nearly 12% of total years lived with disability.1 According to the cross sectional WHO world health survey, carried out in all regions of the world (60 countries), the one year prevalence of a depressive episode (international classification of diseases, 10th revision) was 3.2% (95% confidence interval 3.0% to 3.5%). In patients with several medical conditions the prevalence of depression exceeds that of the general population,2 with 5-10% of patients affected in primary care and 10-14% of patients under general hospital care.3 The diagnosis and treatment of depression by general practitioners is not, however, always optimal.4 5 We review the presentation and assessment of depression and discuss the options for its effective treatment and management.
Sources and selection criteria
Why is depression so difficult to diagnose?
Box 1: Two screening questions for depressionWhat should be taken into account while building a management plan?
Box 2: Components of a comprehensive management plan for depression. Adapted from American Psychiatric Association and World Federation of Societies of Biological Psychiatry guidelines9 10Which treatment setting?
How is depression managed in the acute phase?
Psychological treatmentsPharmacological treatmentCombination of pharmacological and psychological treatmentsHow should treatment efficacy be evaluated?
Box 3: Evaluating the efficacy of treatment for depression. Adapted from World Federation of Societies of Biological Psychiatry guideline10What should be done if patients do not respond to treatment in the acute phase?
How is depression treated in a continuation phase?
Which patients need maintenance or prophylactic treatment?
Box 4: Factors associated with increased risk for depression recurrence. Adapted from World Federation of Societies of Biological Psychiatry guideline10Tips for non-specialistsOngoing researchAdditional educational resourcesInformation for patients

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