We must question the basis of the guidelines themselves

The Hampshire depression project, published recently, was a large well designed randomised controlled study of teaching practitioners about the recognition and management of depression and using patient improvement as the outcome measure. Its results were disappointingly negative, failing to show any increase in recognition or patient recovery rates.1 These findings herald the need for a major change in thinking about improving the management of depression in primary care.

Through the 1990s educational initiatives have been mounted to implement expert guidelines on depression—based on the promising results of a study of educating 18 general practitioners in Gotland.2 A two day course on recognising and managing depression given by psychiatrists was followed by increased antidepressant prescribing and decreased use of tranquillisers. Admissions for depression and the suicide rate both went down. The costs of the exercise were only 0.5% of the savings on admissions.

Subsequently, consensus guidelines on recognising and managing depression appeared in the United Kingdom.3 The Royal Colleges of General Practitioners and Psychiatrists mounted the “defeat depression” campaign, disseminating booklets and videotapes based on the guidelines. The Royal College of General Practitioners appointed a senior mental health education …