The type of treatment matters less than ensuring it is done properly and followed up

Primary care p 772

Several recent studies have evaluated alternative approaches to managing depression in primary care. The range of disease and the treatments examined have varied widely, no doubt contributing to the variation in results. Nevertheless, randomised trials leave little doubt that antidepressant drugs are efficacious in major depression, 1 2 and recent evidence suggests efficacy in dysthymia and subsyndromal depression as well.3 But what role does counselling play in the primary care management of patients with various forms of depression? Recent trials in primary care have produced conflicting results and conclusions.

The paper in this issue by Chilvers et al (p 772)4 and an earlier report from the same study5 address three important questions about treating major depression in primary care. Is there a difference in the effectiveness of drugs versus counselling? Is the non-standardised counselling provided by most mental health providers effective? Does matching treatment …