Identification and management of depression in primary care settings. A meta-review of evidence

Aim - The purpose of this review is to summarize the evidence base on the effectiveness of (a) screening for depression in primary care; (b) managing depression in primary care employing specific management strategies; (c) treating primary care depressive patients with antidepressants. Methods - Meta-review of all available reviews of the evidence. Results - Screening alone does not improve the recognition, management and outcome of depression in primary care settings. Management strategies, including (a) training primary care staff, (b) consultation-liaison, (c) collaborative care, (d) replacement/referral are supported by insufficient evidence to provide a definite answer as to the clinical effectiveness of individual models. Robust evidence exists to encourage physicians to prescribe effective doses of antidepressants in patients with moderate to severe depression who seek treatment in primary care settings. Conclusion - Population-level screening campaigns have a negative ratio of costs to benefits. However, at an individual-level of care increasing the ability of primary care physicians in recognising depression remains a relevant factor. Primary care physicians should consider whether depression is mild, moderate or severe. This patient categorisation help develop appropriate management and therapeutic strategies.