18,22-27 Remarkably, these findings apply even to most recent studies, even after many years of action to improve GPs’ ability to recognize the presence of depressive disorder in patients.19 Out of all the mental disorders, depression has certainly received the greatest attention, in terms of both indirect evidence from community studies and direct evidence by investigations in primary Inhibitors,research,lifescience,medical care settings. A comprehensive community survey, the ICPE (which reanalyzed data from the general population in 6 countries2), recently examined the general population who had suffered a depressive disorder in the past 12 months: only about a fifth in Canada (22%) and the USA

(22%), and slightly more in the Netherlands (32%) and Germany (29%), actually received any type of treatment. The key role of primary care was strongly confirmed in this study, in that the vast majority of patients Inhibitors,research,lifescience,medical in all countries were cared for exclusively in the primary health care sector. Few received treatment from mental health specialists. It is noteworthy that intervention or treatment in this analysis was

merely defined as any treatment contact, irrespective of appropriateness in terms of type, dose, and duration of treatment. A further disturbing finding from community studies is that, for the majority of patients, it takes Inhibitors,research,lifescience,medical many years from the first onset of their disorder to Inhibitors,research,lifescience,medical the prescription of appropriate treatment.28 The recent German study, Depression 2000, was based on a national representative sample of 412 GPs and had a three stage design29 in 15 081 consecutive primary care attendees. This study revealed that of the 11% of patients meeting diagnostic criteria for DSM-IV episode of MD in this

study, two thirds were recognized by the primary care practitioner as having a clinically severe mental health Inhibitors,research,lifescience,medical problem, but only 39% were inhibitors correctly diagnosed as definitely having depression, and an additional 16% as having a probable depression. Recognition rates were especially poor in males (correct identification old rate 27%) and females (33.2%) aged less than 40 years.30 If the treatments chosen worked equally well in all types of mental disorders, then the poor recognition of depression would not be an important issue. However, it is noteworthy that the unsatisfactory recognition pattern and the diagnostic imprecision had remarkable effects on the doctors’ subsequent intervention behavior: more than 40% of all patients meeting DSM-IV criteria for MD did not receive any treatment or significant intervention of any kind! MD cases correctly recognized as at least “probable depression” by the GP had the greatest likelihood (65%) of receiving first-line antidepressants (37%), psychotherapy (9%), or being referred to a mental health specialist (22%).