Managing depression in the primary care setting

It is estimated that depression is the third most common reason for GP consultations in the UK (National Institute for Health and Care Excellence (NICE), 2015). Statistics from 2014 reveal that there was a 1.5% increase from 2013 to 19.7% of patients over the age of 16 years in the UK suffering from either anxiety or depression (Mental Health Foundation, 2018). However, depression is often under-diagnosed and incorrectly treated (Smith et al, 2002). This article will explore the definition of depression, treatment options in adults and prescribing practice in primary care. The management of depression in children, adolescents and pregnant patients is beyond the remit of this article.

Depression is characterised by persistent low mood and/or loss of pleasure in most activities and a range of associated emotional, cognitive, physical, and behavioural symptoms (NICE, 2015). The DSM-5 diagnostic criteria requires the presence of at least five out of a possible nine symptoms (Table 1) over a 2-week period for a diagnosis to be made (American Psychiatric Association (APA), 2013). The symptoms must include persistent low mood and/or loss of interest or pleasure in all or almost all activities most days (APA, 2013). Other associated symptoms include weight loss/gain, appetite change, slowing down of thought or physical movement, fatigue, feeling of worthlessness, poor concentration and suicidal ideation (APA, 2013; Cleare et al, 2015; NICE, 2015; MacKinnon et al, 2019).