Continuing to defeat depression.

IN 1991 an editorial in the Journal reported a new initiative on depression supported by the Royal College of Psychiatists and the Royal College of General Practitioners.1 This defeat depression campaign aimed to raise the medical profession's awareness of the illness and to embark on an ambitious project to educate the general public. The vast majority of people with depression present to their general practitioners, not necessarily complaining of depression, and about 90% are managed without referral to a psychiatrist.2'3 However, many sufferers from this painful and distressing disorder do not consult a doctor and many who do consult are not recognized as being depressed, often because they describe physical symptoms rather than mental distress. We know that modern treatment is effective and that approximately 70% of recognized patients respond promptly to the first course of therapy,4'5 which may be antidepressant therapy, psychological treatment or both. Efforts to encourage depressed patients to seek help and for general practitioners to improve their recognition of the illness through continuing medical education are clearly worthwhile. A major barrier to patients approaching their doctor is the stigma still associated with mental disorder. Lack of public awareness contributes to this continued stigma, and the fear of being labelled as 'depressed' causes unnecessary suffering.6 A poll conducted at the start of the defeat depression campaign showed a general lack of knowledge and understanding of mental disorders among the general public.7 Most people felt that is was easier to sympathize with sufferers of physical illness than those with mental disorders because physical illness is easier to see and understand. The first step of the defeat depression campaign was to establish an effective working relationship between the two royal colleges in order to foster the best possible care for depressed patients. A joint venture examining the research evidence, together with the clinical experience, of both specialists and general practitioners led to a consensus statement on diagnosis and management. This has been disseminated both as a formal paper8 and as simplified guidelines. It is recognized that distinct groups of patients have somewhat different needs, requiring different approaches and communication skills. The shared care of patients with depressive illness is an important feature of the campaign.9 There has been a high level of cooperation and involvement, not only of doctors and nurses, but other health professionals and representives of patient organizations. What is general practice doing to improve the opportunities …