Treating Depression in Primary Care: Initial and Follow-Up Treatment Strategies

Depression can be effectively treated in primary care settings when clinicians follow guidelines for selecting treatment and monitoring response. Initial treatment options include pharmacotherapy, psychotherapy, electroconvulsive therapy, and exercise. Clinicians must be aware of the efficacy and tolerability profiles of antidepressants as well as the available forms of psychotherapy, including cognitive-behavioral therapy, interpersonal therapy, and mindfulness-based cognitive therapy. Follow-up after treatment initiation must include monitoring response, functional status, adverse effects, and adherence. For patients with inadequate response, clinicians must be prepared to switch or augment treatment as needed.

From the Department of Family Medicine, University of North Carolina, Chapel Hill, and the Mood Disorders Clinic, Moses Cone Family Practice Center, Greensboro (Dr Manning); and the Departments of Family Medicine and Psychiatry, University of Tennessee College of Medicine, Memphis (Dr Jackson).