[Improving the management of depression in primary care: review and prospects].
L'Encéphale. 2007-09-01; 33(4): 552-560
DOI: 10.1016/s0013-7006(07)92052-7
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1. Encephale. 2007 Sep;33(4 Pt 1):552-60. doi: 10.1016/s0013-7006(07)92052-7.
[Improving the management of depression in primary care: review and prospects].
[Article in French]
Rotgé JY(1), Tignol J, Aouizerate B.
Author information:
(1)Service Universitaire de Psychiatrie du Professeur Tignol, Centre Hospitalier
Charles-Perrens, 121, rue de la Béchade, 33076 Bordeaux cedex.
BACKGROUND: Depression is a common disorder, associated with significant social
and functional impairment, and whose natural course tends to chronicity. The
majority of the patients suffering from this disorder are attended in primary
health care settings. General practitioners represent the greatest part of the
prescribers of antidepressants. Unfortunately, there are many barriers with
detection and with the treatment of depression, thus only a minority of patients
profits from a treatment with effective posology and with sufficient duration.
LITERATURE FINDINGS: Several programs of interventions directed by mental health
professionals aim at improving the management of depression in primary care.
There are single interventions consisting of an educational program to
physicians or a single intervention to the patient. The assessments of an
educational strategy find some contradictory results. Single interventions are
not sufficient by themselves. On the other hand, programs associating several
interventions are effective. These associations consist of an educational
intervention to the physicians and an intervention or more to the patient
treated by antidepressant. Interventions are generally carried out by nurses and
supervised by a psychiatrist. Mental health professionals share their
informations with general practitioners. Interventions can be telephone or in
. Telephone interventions have the advantage of a low cost and
appear quite as relevant as interventions in .
RESULTS: But the effectiveness of these programs grows blurred in time, unless
the program itself does continue. Moreover, this effectiveness is variable
according to the severity of symptomatology. Indeed, the interest of this type
of programs for the patients suffering from minor depression is limited. These
various programs can be supplemented by the contribution of tools of detection
or assessment of the depressive symptomatology to general practitioners, like by
the contribution of oral and/or written informations to the patient concerning
the disorder from which he suffers. The setting-up of such programs represents a
considerable cost but depression is itself responsible for an important cost for
our society. Several estimates concerning the setting-up of these programs find
a good cost-effectiveness ratio; it should facilitate their installation taking
into account their effectiveness.
CONCLUSION: A close cooperation, based on the complementarity between general
practitioners and mental health professionals is required to improve the
management of depression.
DOI: 10.1016/s0013-7006(07)92052-7
PMID: 18033142 [Indexed for MEDLINE]