Improved ability to identify symptoms of major depressive disorder (MDD) in general practice

The diagnosis and treatment of major depressive disorder (MDD) is a primary care responsibility in most countries, yet although most people with MDD present to their primary care team at some time during the course of their illness, the majority remain unrecognized and fewer still are effectively treated. Large-scale epidemiological studies have helped to identify several factors that influence recognition rates of MDD in primary care. Patients who present with psychological symptoms and clearly communicate their disability are more likely to be recognized than those who present with somatic symptoms or concurrent physical illnesses. Fatigue, loss of energy and poor motivation are core symptoms Of depression in most patients, but are rarely interpreted as psychological symptoms and frequently mislead the primary care physician into searching for a somatic cause. If primary care recognition rates for MDD are to improve substantially, patients must be encouraged to seek help if they are suffering from these three core symptoms, and primary care physicians must increase their index of suspicion for MDD if a patient presents with them. Simple screening tools such as the Mini-International Neuropsychiatric Interview (MINI) can help to improve recognition rates significantly and should be applied routinely in primary care.