BMJ  2008;336:435-439 (23 February), doi:10.1136/bmj.39478.609097.BE

Clinical Review

Management of depression in adults

¹ Institute of Health Sciences, University of Oulu, Box 5000, FIN-90014, Finland, ² Department of Psychiatry, Savonlinna Central Hospital, Finland

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.

Summary points Somatisation is one of the most important single problems associated . . . [Full text of this article]

Sources and selection criteria

Why is depression so difficult to diagnose?

Box 1: Two screening questions for depression

What 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 guidelines^{9 10}

Which treatment setting?

How is depression managed in the acute phase?

Psychological treatments
Pharmacological treatment
Combination of pharmacological and psychological treatments

How should treatment efficacy be evaluated?

Box 3: Evaluating the efficacy of treatment for depression. Adapted from World Federation of Societies of Biological Psychiatry guideline¹⁰

What 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 guideline¹⁰
Tips for non-specialists
Ongoing research
Additional educational resources
Information for patients

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