Primary Care Doctors: Treat or Refer Depressed Patients?

Cynthia Starr, MS, RPh


July 21, 2011

In This Article


Primary care doctors are encouraged to screen patients for depression. But when they identify depressed patients, then what?

The National Institute of Mental Health estimates that about 12% of patients seen in primary care practices have major depression. Yet, a large proportion of these are undiagnosed, according to Ruth Shim, MD, MPH, Assistant Professor, Department of Psychiatry and Behavioral Sciences, and Associate Director of Behavioral Health, National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia.

"Primary care doctors can and do effectively treat mild to moderate depression," says Shim.

In fact, once identified, most patients are treated in general medical offices rather than mental health centers. Studies indicate that patients, particularly members of racial or ethnic minorities, prefer it this way.

Part of the problem is lingering stigma -- nobody knows that you are seeking treatment for a psychiatric illness when you enter a primary care office, Shim notes. Care is also more accessible; it can be harder to get into the mental healthcare system, especially if you're underinsured or uninsured.

Many psychiatrists also prefer that primary care physicians oversee treatment of mild-to-moderate depression -- and anxiety, for that matter. "We need primary care physicians to treat people with less severe illness so we can focus on people who have more complex conditions," Shim remarks. "That improves access for everybody, because right now, you have to wait a long time to see a psychiatrist, particularly in public settings."

According to Shim, screening is best accomplished with the brief 9-item Patient Health Questionnaire (PHQ-9). Patients are asked how often they experience certain problems, such as lack of interest in activities, trouble sleeping, loss of appetite, inability to concentrate, and thoughts about death. Easy to use and score, this tool allows you to determine the severity of the illness, Shim explains.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.