Intended for healthcare professionals

Clinical Review State of the Art Review

Depression in primary care: part 2—management

BMJ 2019; 365 doi: (Published 08 April 2019) Cite this as: BMJ 2019;365:l835
  1. Parashar Ramanuj, consultant psychiatrist, senior research fellow12,
  2. Erin K Ferenchick, assistant clinical professor of medicine3,
  3. Harold Alan Pincus, professor and vice chair, co-director, senior scientist456
  1. 1Center for Family and Community Medicine, Columbia University Medical Center, New York, NY, USA
  2. 2Royal National Orthopaedic Hospital
  3. 3RAND Europe
  4. 4Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
  5. 5Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
  6. 6RAND Corporation, Pittsburgh, PA, USA


Depression is a common and heterogeneous condition with a chronic and recurrent natural course that is frequently seen in the primary care setting. Primary care providers play a central role in managing depression and concurrent physical comorbidities, and they face challenges in diagnosing and treating the condition. In this two part series, we review the evidence available to help to guide primary care providers and practices to recognize and manage depression. The first review outlined an approach to screening and diagnosing depression in primary care. This second review presents an evidence based approach to the treatment of depression in primary care, detailing the recommended lifestyle, drug, and psychological interventions at the individual level. It also highlights strategies that are being adopted at an organizational level to manage depression more effectively in primary care.


  • Clinical review, doi: 10.1136/bmj.l794
  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: All three authors made substantial contributions to the conception or design of the work and the acquisition, analysis, or interpretation of data for the work and to drafting the work or revising it critically for important intellectual content; had final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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