Heidi M. Oetter, MD [1], Raymond W. Lam, MD, FRCPC [2]
This is the second of a two-part theme issue on depression in primary care. The first part (BCMJ October 2002) described newer systems of care and presented easily used diagnostic and assessment tools. This part contains an article on recognizing depression in the young and the elderly [3]—distinct populations that offer unique diagnostic challenges. The other articles focus on having the best evidence for treatment options at your fingertips (Treatment of depression in primary care—Part 1 [4] and Part 2 [5].)
The challenges of diagnosing and treating depression in the primary care setting are real. Depression is a very common problem in the average family doctor’s office. Often a co-morbid factor in many other diseases, depression is a significant burden on the health care system. Despite the prevalence and incidence of depression, many people receive less than adequate care. Most communities lack sufficient numbers of psychiatrists. Family doctors in BC, unlike in most other provinces, cannot bill the provincial medical plan for psychotherapy. Relatively few patients have the luxury of an extended health insurance plan, and many plans are woefully inadequate in covering counselling or psychology services. And the cost of medication can be another obstacle!
In a sometimes bewildering world of treatment options, evidence-based clinical practice guidelines are tools for improving care plans. We have summarized the guidelines on treatment of depression developed by the Canadian Network for Mood and Anxiety Treatments (www.CANMAT.
org [6]) in this issue. We have tried to make these summaries as user-friendly as possible for the busy family physician. However, we recognize that publishing these articles in isolation is not likely to have a significant impact on clinical care. Hence, the Guidelines and Protocols Advisory Committee, jointly sponsored by the BC Medical Association and the BC Ministry of Health Services, has created a work group to develop processes to put these guidelines into action. Ideas include a physician tool kit, case-based workshops, case management, and a referral network. Using novel, multimodal approaches may be the most effective way to ensure that clinical guidelines actually make a difference to our patients.
—Heidi Oetter, MD,
Department of Family Practice and Department of Psychiatry,
Royal Columbian Hospital, New Westminster, BC
—Raymond W. Lam, MD, FRCPC,
Professor and Head, Division of Clinical Neuroscience, UBC, and
Director, Mood Disorders Centre, UBC Hospital