Text adapted from "The patient who is depressed" in Psychiatry in primary care by Raymond W. Lam, (CAMH, 2019).
Depression is a common psychiatric disorder that primary care practitioners often see in their practice. In Canada, about five per cent of people aged 15 and older have experienced a major depressive episode in the past year, and about 11 per cent of adults will meet criteria for major depressive disorder in their lifetime. The prevalence of depression is highest among people of typical working age (15–64 years), making the disorder one of the leading causes of work-related disability and lost productivity (Pearson et al., 2013).
The Primary Care Practioner Role
What Is Reasonable to Expect of a Primary Care Practitioner?
- Make a diagnosis and develop a treatment plan.
- Assess suicide risk.
- Monitor treatment response and outcome. Full remission of symptoms is an important goal for both acute and maintenance treatment.
- Coach the patient in self-management and use problem-solving therapy techniques.
- Manage medications. Be familiar with at least two classes of antidepressants and at least one augmentation strategy.
When to Refer to a Specialist
- Complicating comorbidity (substance use, personality disorder, anxiety disorder)
- Severe presentation (serious suicidality; psychosis; bipolar disorder, especially bipolar I with manic episodes)
- Diagnostic clarification (bipolarity, personality comorbidity)
- No response to standard treatment (CBT, two or more medication trials)
- The Primary Care Practitioner Role
- Screening & Assessment
- Clinical Tools
- Resources & References