TY - JOUR T1 - Effective management of depression in primary care: a review of the literature JF - BJGP Open JO - Br J Gen Pract Open DO - 10.3399/bjgpopen17X101025 VL - 1 IS - 2 SP - bjgpopen17X101025 AU - Bruce Arroll AU - Fiona Moir AU - Tony Kendrick Y1 - 2017/07/10 UR - http://bjgpopen.org/content/1/2/bjgpopen17X101025.abstract N2 - There is an argument that clinicians are medicalising normal human suffering in many of their patients. In his, book Beyond Depression, Chris Dowrick says '… our culture is imbued with an expectation of happiness, and that in consequence we tend to see negative emotional experiences as aberrant and deviant'.1 He proposes 'an approach to patients which emphasises listening and understanding rather than diagnosis and prescription.' Many GPs will be sympathetic to these views, but nevertheless have to respond to patients’ needs while wrestling with time pressure and limited access to non-drug therapies. The temptation is to follow the biomedical model of diagnosis and treatment.Depressive symptoms range on a continuum from everyday sadness to suicidal despair, and a challenge for practitioners is deciding at what level to intervene. A clinical definition of depression is therefore necessary to inform clinical decisions, enable research to be conducted, and justify insurance payments. The most widely accepted definition of depression comes from the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. The DSM-5 outlines three degrees of severity (mild, moderate, and severe) based on a required number of symptoms and the degree of functional impairment. The presence or absence of psychotic features, such as hallucinations or paranoia, help determine specific treatments.The National Institute of Health and Care Excellence (NICE) recommends the use of depression symptom inventories to assess severity and to monitor improvement.2 Commonly used inventories include the patient health questionnaire 9 (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS). While they are not considered diagnostic tools they have been validated against gold standard clinical interviews and can be very handy for use in a busy primary care clinic. Their main use is in giving a measure of severity and in monitoring the progress of treatment. … ER -