Summary

• Major depressive disorder, a common medical disorder with clinically significant morbidity and mortality, is often undiagnosed and undertreated.
• Detection of a major depressive episode in the primary care setting often requires a high index of suspicion.
• Case-finding (or screening) instruments can be used for early detection, verification of clinical impression, or data collection and documentation.
• Optimal treatment of a major depressive episode depends on whether it represents an episode of recurrent major depressive disorder or bipolar disorder, or if it is a consequence of medical illness or substance abuse.
• A therapeutic trial of antidepressant medication constitutes a sufficient dosage taken for a sufficient period of time.
• Nonpharmacologic antidepressant therapies include brief psychotherapy, exercise, and light therapy; these are effective either alone or in combination with antidepressant medication.

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