Rapid diagnosis and treatment of anxiety and depression in primary care: the somatizing patient.

The somatic presentations of anxiety, mixed anxiety and depression, and depressive disorders are commonly seen by primary care physicians, and several studies have indicated that patients who present with such psychiatric disorders in the primary care setting often do not have their disorders appropriately diagnosed. Underlying psychosocial problems often hide behind somatic screens. When physicians fail to relate the somatic symptoms to the feelings that motivated the visit, the subsequent negative workup or poor response to therapy can compromise the patient's recovery and level of satisfaction. Although not equivalent to an extensive clinical interview, the Goldberg depression screening scale and the author's SWIKIR anxiety screening scale can be used to substantially reduce the number of undiagnosed, readily treatable psychiatric disorders in the primary care population. Once an accurate diagnosis has been obtained, psychotropic medications can be used to safely and effectively manage anxious and depressed patients. Selective serotonin reuptake inhibitors have proved extremely effective in the treatment of major depression, and buspirone has excellent efficacy for the management of generalized anxiety disorder.