Diagnosis and Treatment of Major Depression 2007

Clinical Evidence Review: Best Practice

By Patricia deSa, MS; David W Price, MD, FAAFP



Depressive syndromes are commonly seen in the primary care setting. The National Institute of Mental Health estimates that 9.5% of adult Americans (about 19 million people) suffer from Major Depressive Disorder (MDD).1 Within Kaiser Permanente (KP), the overall prevalence of depression is about 8.4%,2 and direct medical costs to care for members with depression exceeds $2 billion annually.3

In the primary care setting, treatment of depression usually includes evaluation by a physician, brief patient education, and either antidepressant therapy, referral to a behavioral health specialist or, in severe, resistant, or chronic cases, both a prescription and a referral. Although most depressed patients can be successfully treated by primary care clinicians, depression remains unrecognized or undertreated in many patients.

The first Major Depression Clinical Vignette, based on the 2002 CMI guideline, was published in the Winter 2002 issue of The Permanente Journal.4 This article discusses updated MDD diagnostic and treatment recommendations, based on the 2006 CMI Guideline for the Treatment of Major Depression in Adult Primary Care patients,5 and new evidence from the Sequenced Treatment Alternatives for Resistant Depression (STAR*D) trial.6-10


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