Depression comes in many disguises to the providers of primary care: recognition and management.

Depression is encountered frequently in the primary care setting. Its appearance is dominated by the physical symptoms of the syndrome. This factor, when combined with the residual stigma that mitigates against acceptance of the diagnosis, probably accounts for how often the diagnosis is missed. The depressive illnesses are serious, disrupting occupational and social functioning to a significant degree. They are life-threatening for some in the short-term, but for many more over a lifetime, as depression is more often recurrent or chronic than a one time experience. With a psychiatric nomenclature now available that is user-friendly, screening tests that are available and easy to administer, and treatments that are successful, it is important that the physician learn to recognize and manage this common set of problems. Depression is typically co-morbid with serious medical illness, and often co-morbid with complicating emotional disorders. It may appear in a form that takes a bipolar course, including episodes of mania and hypomania. The physician in practice must decide which patients with depression he or she will treat, and who to refer for specialty care. The SSRI anti-depressants are usually the frontline treatment of choice. Bipolar, treatment-resistant, and difficult patients with co-morbid psychiatric illnesses should be referred to psychiatrists. It is valuable for the physician to have psychiatrists he or she knows to facilitate consultation, communication and coordination. The value of brief psychotherapy in the treatment of a depressive episode underlines the need for a psychiatrist with whom the physician can work collaboratively. The depressed patient presents the physician with a situation in which he or she can make a positive difference in the life of a person and his or her family. The need to model and teach the treatment of depression in primary care is evident, with the likelihood that this will be the arena in which these patients will continue to receive care.