TY - JOUR T1 - We need a chronic disease management model for depression in primary care JF - British Journal of General Practice JO - Br J Gen Pract SP - 348 LP - 350 VL - 57 IS - 538 AU - Andre Tylee AU - Paul Walters Y1 - 2007/05/01 UR - http://bjgp.org/content/57/538/348.abstract N2 - The treatment of depression as described by steps 3 and 4 in the NICE guidelines for the management of depression are a particular challenge for primary care.1 There is now an increasing body of evidence that suggests depression, for a lot of people, is a chronic illness that leads to ongoing suffering and disability. Between 50 and 70% of patients with depression treated in the primary care setting with antidepressant medication showed a response. In a recent review of treatment for depression, a meta-analysis comparing antidepressants with placebo showed a relative risk for improvement on antidepressants over placebo of between 1.12 and 1.55, and a number needed to treat of between four and six.2 This means that for every person who responds, three to five people will not. This is likely to be similar for psychological treatments such as cognitive behavioural therapy (CBT). Response in the research sense is usually defined as a 50% improvement in symptoms from baseline. This means that even in patients who respond, many patients will remain symptomatic. Remission, defined by researchers as an improvement to minimal or no symptoms, is achieved in far fewer patients. Using remission as an outcome, antidepressants perform poorly. Fawcett and Barkin found that only 30% of patients treated with an antidepressant actually achieved remission.3 Compounding this, fewer than 10% of patients will actually complete a course of antidepressants for the recommended duration.4Achieving remission is important for a number of reasons. Residual symptoms of depression are associated with ongoing suffering and disability, and are also associated with a far greater likelihood of relapse. Paykel et … ER -