Improving outcomes for patients with major depression is not as simple as prescribing a new treatment

Goldberg and Von Korff

They wrote: "Improving outcomes for patients with major depression is not as simple as prescribing a new treatment: the whole process of care needs to be enhanced."

The BMJ editorial highlights research carried out across 14 countries, which found patients with major depression were just as likely to be treated with sedatives as antidepressants.

This is despite evidence that antidepressants have been shown to be more effective three months after treatment began.

Two thirds of patients still had a diagnosis of mental illness a year after their initial diagnosis and in nearly half the diagnosis was still major depression.

The authors say to improve care, changes in the way care is organised need to happen.

They suggest initiatives including a case manager for each patient, better monitoring of patients and better links from primary to psychiatric care.

Better care

Von Korff and Goldberg write: "Change is hard for overtaxed healthcare teams, and many might be tempted to adopt quality improvement strategies that are quick and easy.

"Such strategies do not usually work however, as single initiatives."

They add: "Enhanced care for people with depression will go a long way towards improving the lives of these patients.

"But the large gap in the quality of care cannot be closed only by the increased efforts of individual practitioners who are already overburdened.

"The question now is whether insurers and organisations that provide patient care will act on the scientific evidence to benefit the millions of people worldwide who are afflicted by major depression."

Marjorie Wallace, chief executive of the mental health charity SANE, said: "Through talks with mental health professionals and people on the front line of the mental health service, it is clear that despite all the promises and efforts to modernise services, mentally ill people and those responsible for their care continue to be let down badly by the system."

SANE called for:

• More rights for patients, their families and carers
• Early intervention and up-to-date treatments
• A holistic approach to treatment
• More intensive support for people who can no longer live alone or with their families, either through hospital places or 24-hour nurses units.