Met and unmet needs in the management of depressive disorder in the community and primary care: the size and breadth of the problem.

Numerous epidemiologic studies have revealed the high prevalence of depressive disorders despite the availability of several treatment options that have been proved to be efficacious and safe. The persistence of depression, at a time when treatment options have increased, suggests that there are unmet needs in the clinical management of depression. Aside from improving treatment guidelines, the role of primary care physicians should be redefined to ensure that lifetime depressive disorders are more frequently recognized, diagnosed, and appropriately treated and managed, either by these clinical "gatekeepers" or through referrals to mental health specialists. With this management strategy, access to care can be broadened to include not only the severely ill, but also patients in earlier stages of their depressive illness process who might profit most from modern treatment methods.