Tackling depression

We've all heard the statistic that one in five of us will have depression at some time in our lives, but few of us will have been moved to act upon it either for patients or ourselves. Depression has traditionally been considered to be the domain of psychiatrists and primary care doctors, which has led to patients' management tending to become confined to these areas. But depression is seen in all specialties.

Left undiagnosed, depression can worsen the prognosis of almost all conditions. So to provide the best care for patients, it is essential for all junior doctors to be equipped with the skills to recognise, assess, and treat depression.

Depression is an internationally recognised disease. That it is for the fourth greatest contributor to the global burden of disease shows its cross cultural importance.1 The World Health Organization predicts that by 2020 depression will have risen to first place, representing 154 million people worldwide. The prevalence of depression in the community in the United Kingdom is 6.3%-17.1%.2 Because each episode may last several months, the burden that depression renders upon society is great. This corresponds to a yearly cost of £9bn (€12bn; $18bn)3 in lost earnings; 110 million missed working days; and a cost to the National Health Service of £369m, of which only 11% is spent on drugs.4 In the United States the yearly cost is $83bn. Depression is important on an individual level in terms of disability and misery, but it also has this wider economic impact on us all.

It is all too easy to compartmentalise medicine—newer modularised clinical courses tend to encourage this—each specialty forgotten as we file away the rotation's notes. However, evidence …