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Evidence-Based Clinical Vignettes from the Care Management Institute: Major Depression.

Depressive syndromes are commonly seen in the primary care setting. Major depression affects 4.8% to 8.6% of the general US population in any given year; other types of depression affect an additional 3% to 8.4% of patients.1 Total costs of depression, including direct medical costs and indirect costs due to days lost from work, exceed $43 billion annually.1,2 
 
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 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. 
 
In 2001, the Kaiser Permanente Care Management Institute (CMI) revised its guideline for evidence-based care of depressed adult outpatients in the primary care setting.3 This article and case example highlight key steps and recommendations from this guideline.