Understanding how primary care clinicians manage depression is a key backdrop to current and future initiatives to improve detection and treatment of depression. We systematically reviewed, identified, and extracted findings from 13 qualitative studies that examined general practitioner (GP) management of depression. We assessed articles for quality using Critical Appraisal Skills Program guidelines for assessing qualitative research but did not exclude any articles based on quality. We carried out a thematic analysis for systematic review of qualitative research in which we identified four main themes with various subthemes: "negotiating the nature of depression," "detect and diagnose," "interventions," and "burden." The results of the analysis illuminate the complex dilemma faced by GPs in managing depression, which appears to be characterized by a sense of dissonance between the medicalization of depression and a sense of its social determinants.