Met and Unmet Needs in the Management of Depressive Disorder in the Community and Primary Care: The Size and Breadth of the Problem

Numerous epidemiologic studies have revealed the high prevalence of depressive disorders despitethe availability of several treatment options that have been proved to be efficacious and safe. The persistenceof depression, at a time when treatment options have increased, suggests that there are unmetneeds in the clinical management of depression. Aside from improving treatment guidelines, the roleof primary care physicians should be redefined to ensure that lifetime depressive disorders are morefrequently recognized, diagnosed, and appropriately treated and managed, either by these clinical"gatekeepers" or through referrals to mental health specialists. With this management strategy, accessto care can be broadened to include not only the severely ill, but also patients in earlier stages of theirdepressive illness process who might profit most from modern treatment methods.