Contents Previous Next

Part II - Foreword

This Clinical Practice Guideline (Depression in Primary Care: Volume I. Detection and Diagnosis; and Volume 2. Treatment of Major Depression) was developed with support from the Agency for Health Care Policy and Research (AHCPR) by the Depression Guideline Panel to assist primary care providers (e.g., general practitioners, family practitioners, internists, nurse practitioners, registered nurses, mental health nurse specialists, physician assistants, and others) in the diagnosis of depressive conditions and the treatment of major depressive disorder. The panel hopes that the general principles embodied in these guidelines will also provide a framework for other medical and non-medical practitioners who assume responsibilities for the recognition and care of depressed persons. Depression was selected as a topic for guideline development because:

  1. Depressive disorders are commonly encountered in primary care, as well as in other treatment settings.
  2. Most depressed patients seek care from primary care practitioners.
  3. A range of effective treatments are available and commonly provided for these conditions.
  4. There is a large body of scientific evidence on which to base these guidelines.
  5. Practice surveys indicate that improvements are needed in primary care practitioners' ability to recognize and treat depressive disorders.
  6. Depressive disorders result in significant morbidity and mortality.
  7. Depressive disorders have a high prevalence in the general population.

These guidelines are not aimed at rendering selected procedures reimbursable or not reimbursable; that decision logically falls to third-party payors. Nor do they specify which professionals should conduct which procedures, an issue addressed by licensing/privileging bodies. Should the recommended steps in the diagnosis or treatment of depression fall outside the expertise of the practitioner, he or she should seek a consultation with, or a referral to, someone knowledgeable in these matters.

The Depression Guideline Panel is comp9osed of experts from diverse disciplines, as well as a consumer representative. The guidelines are based on systematic literature reviews commissioned by the panel and conducted by experts in numerous areas relevant to depression, with special attention to the clinical issues most pertinent to diagnosis and treatment of depression in primary care. Guideline development also included input from a broad range of professional and consumer organizations and individuals. The guidelines have undergone peer review and field review with intended users in clinical sites to evaluate the document both conceptually and operationally. For practitioners, patients, and their families, we hope these guidelines provide a richer understanding of depression. For researchers, we hope we have identified key areas of uncertainty for further investigation.

Research develops knowledge. The synthesis and specification of current knowledge do not mitigate (in fact increase) the need for careful translation and application of this knowledge. However, in many cases they have to act without sufficient scientifically based data.

The panel's inferences as to what is optimal patient care are not expected to apply to all patients or situations. Knowledge developed through research can only provide a starting point for approaching a particular patient. Algorithms are not applicable in every case, and often provide coarse road maps for managing patients. Adaptation of guidelines to particular patients requires practitioners to have skill, training, knowledge, and experience, and patients and families to have patience, understandings, trust, and knowledge.

This is the first edition of the Clinical Practice Guideline. We plan to revise the guidelines based on new knowledge, empirical evaluation of their impact on patient outcome, and critiques from users. The panel welcomes comments and suggestions for use in the next edition. Please send written comment s to Director, Office of the Forum for Quality and Effectiveness in Health Care, AHCPR, Executive Officer Center, Suite 401, 2101 East Jefferson Street, Rockville, MD 20852.

Contents Previous Next