Reinventing Depression: A History of the Treatment of Depression in Primary Care, 1940-2004

Reinventing Depression: A History of the Treatment of Depression in Primary Care, 1940-2004

Reinventing Depression: A History of the Treatment of Depression in Primary Care, 1940-2004

Reinventing Depression: A History of the Treatment of Depression in Primary Care, 1940-2004

Synopsis

To inform future research, treatment, and policy decisions, this book traces the scientific and social developments that shaped the current treatment model for depression in primary care over the past half century. While new strategies for diagnosing and treating depression have improvedmillions of people's lives, there is little evidence that the overall societal burden of depression has decreased. Most experts point to a gap between what psychiatrists know and what primary care doctors do to explain untreated depression. Callahan and Berrios argue, however, that the problem stemsmainly from lack of a public health perspective, that prevailing etiologic models underestimate the roles of society and culture in causing depression and over-emphasize biological factors. The current conceptual model for depression is a scientific and social invention of the last quarter century. Such models are important because they shape how society views people with emotional symptoms, defines who is sick, and determines who should get care. Most parents who seek treatment fordepression receive antidepressant medications in primary care. The authors show that although depressed patients' help-seeking behavior and primary care doctors' clinical approach have changed little over the past half century, the field of primary care medicine has changed dramatically. Theydescribe how the specific diagnoses and treatments developed by psychiatrists in the past 50 years have often collided with the non-specific approaches that dominate primary care practice. In examining the research seeking to close the gap between psychiatry and primary care, Callahan and Berriosoffer public health models to explain the ongoing societal burden of depression. By exploring the history of depression in primary care, they open a pathway for improvements in the care of people with depression, where primary care physicians should play a greater leadership role in thefuture.

Excerpt

Each year, the United States and the United Kingdom spend billions to treat depression. Despite these costs, depression remains one of the most underrecognized, undertreated, and disabling conditions in both countries. At the same time, depression is one of the most common reasons that people seek care from generalist physicians; these primary-care doctors treat most patients suffering from depression. Unfortunately, advances in medical science have not led to a decline in depression in either country.

While new strategies for diagnosing and treating depression have improved millions of people's lives, there is little evidence that the overall societal burden of depression has decreased. In contrast, the application of public health techniques, coupled with antibiotic medications, led to a dramatic decline in morbidity and mortality from infectious diseases in industrialized countries in the twentieth century. Along the same lines, early interventions for the risk factors associated with cardiovascular disease precipitated a decline in morbidity and mortality from heart attack and stroke. Why have we not seen a similar decline in morbidity and mortality from depression? Most experts point to a gap between what psychiatrists know and what primary-care doctors do to explain untreated depression. We argue, however, that untreated depression is caused by a lack of attention to a public health perspective that would emphasize the role of individual and community responsibility.

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