Intended for healthcare professionals


Diagnosing and treating depression

BMJ 2000; 320 doi: (Published 10 June 2000) Cite this as: BMJ 2000;320:1602

Treatment is often challenging

  1. Ward Tolbert Smith, medical director (
  1. Pacific North West Clinical Research Center, Summit Research Network, 1849 NW Kearney Street, Portland, OR 97232, USA
  2. Centre for Rural Health Studies, Whitbourne, Nfld A0B 3K0, Canada
  3. Department of Psychiatry, Memorial University of Newfoundland, Health Sciences Centre, St John's, Nfld A1B 3V6, Canada
  4. Orchard Medical Practice, Ipswich IP4 2PU
  5. Cefn Coed Hospital, Swansea SA2 0GH
  6. Lamlash Medical Centre, Lamlash, Isle of Arran KA27 8NS
  7. University of Southampton Aldermorr Health Centre, Southampton SO16 5ST

    EDITOR—On reading Kendrick's article,1 I was reminded of the notion that individuals seek out a field of medicine that suits the workings of their brain and personality. Surgeons tend to be results oriented, enjoy solving concrete problems with concrete answers, and need closure (no pun intended). Internists have a high tolerance for “not knowing,” living with uncertainty, and allowing problems to stay open, dynamic, a work in progress. Chronic disease is recognised as the human condition. Family practitioners are willing to tackle any problem to the best of their ability, and they can live with the idea that they need to learn more and more to improve their skills. They tend to find the time to upgrade their knowledge in seminars, journals, and other forms of courses. They are typically not deeply versed in any particular field, psychiatry included.

    Depression is a complex illness. Without the sense of “psychological mindedness” that often directs a person into the mental health fields, it is difficult to grasp the full picture of the syndrome of depression. Treatment is often challenging and not as simple as might be implied by the few hours of instruction delivered to the willing participants in the trial.

    The choice of standard antidepressant in the trial is certainly open to some criticism: tricyclics have retreated to an occasional choice in the new world of psychopharmacological agents. We now expect full remission of the syndrome of depression and should seldom settle for less. Psychotherapy as an additional treatment modality has been shown to be a useful tool in the treatment plan and should not be overlooked or relegated to the history books.

    Unfortunately, the proper treatment requires considerable training and experience and a great deal of time—commodities in short supply in the world of the primary care physician. Lest …

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