Depression and demoralisation in primary care; matching taxonomy with evidence-based treatment
To bring together principles of management from evidence based guidelines with taxonomy of depression developed in a general practice setting.
The taxonomy was developed after a series of studies including an observational study of GPs and their patients discussing depression. The main national and international guidelines for the treatment of depression were examined and recommendations matched with taxonomy.
GPs consider distress and depression in three steps. In the first step, a change in a group of symptoms and signs is observed. This signals depression or distress. The second step categorizes the syndrome according to whether or not there is an identifiable environmental cause, with the final step categorizing the reactive syndromes according to their most prominent symptoms; either anxiety and worry, or helplessness and hopelessness – called demoralisation in its severe form. A stepped or tiered model of intervention is then described that links with this taxonomy id described.
A resulting guide linking evidence-based treatments with a parsimonious taxonomy of distress and depression is presented.
