The Role of Algorithms in the Detection and Treatment of Depression in Primary Care

Many depressed patients present to primary care physicians instead of psychiatrists, and severalstudies have found that primary care physicians underdiagnose and undertreat depression. Primarycare physicians may fail to diagnose and treat depression for many reasons: depression as it appears inprimary care is in many ways a different disease than that seen in the psychiatric setting, and the processof detecting and treating it is different as well. Primary care clinicians face 2 main tasks whenaddressing depression in routine practice: to accurately identify those patients who are most likely tobenefit from antidepressant treatment and to provide the best treatment options possible in the limitedtime available per visit. Treatment algorithms can be useful, but they are often difficult to apply inprimary care. This article reviews the evidence about the detection and treatment of depression inprimary care, examines current research on the differences between the primary and specialty careenvironments, and discusses aspects of treatment guidelines and algorithms that are important to primarycare physicians.