How to recognize and treat depression in primary care? Review article

Abstract

Depression is one of the most common mental disorders, with an increasing prevalence – it affects over 10% of the population, with women being affected approximately twice as often as men. In primary care practice, patients with depression account for around 20% of visits, often presenting with somatic symptoms, persistent insomnia, or coexisting chronic diseases. Depression manifests with diverse affective, cognitive, behavioral, and somatic symptoms. The dominant symptom is low mood and anhedonia, often accompanied by guilt, apathy, and a negative view of oneself, the world, and the future. Frequent somatic symptoms can complicate diagnosis, especially in cases of masked depression. Diagnosis is based on ICD-11 criteria and an assessment of the patient’s mental state. In primary care, screening tools such as PHQ-2 and PHQ-9 are useful for the preliminary detection of depression and assessment of its severity. Most patients can be treated in primary care. Referral to a psychiatrist is recommended for patients with severe, chronic, or treatment-resistant depression, those at risk of suicide, during pregnancy, or in complex clinical situations. The goal of treatment is rapid and complete symptom remission, prevention of relapse, and a return to pre-illness functioning. Treatment of mild and moderate depressive episodes includes pharmacotherapy and/or psychotherapy. For moderate to severe depression, the foundation of treatment is antidepressant medication, supplemented as needed with psychotherapy or adjunctive drugs.