Depression is a common illness managed predominantly in primary care but studies have shown that it is often poorly managed, with patients receiving less than optimal duration of treatment and poor adherence being an acknowledged problem. The study incorporates evidence from the current management of depression and views of patients and health professionals into local guidelines for depression.

The study undertaken in 1999 in Wyre Forest PCG involved a retrospective review of antidepressant prescribing in one practice; a self-completion postal questionnaire, sent to a random sample of 200 patients identified from the prescribing review; semi-structured interviews with health professionals from four practices in the PCG and with four community pharmacists.

The prescribing review showed many patients did not have a full six months of antidepressant. From the patient survey only 24 (44%) of the patients no longer taking an antidepressant had taken it for at least 5 months and two patients did not have their prescription dispensed. The main reason patients gave for stopping their medication was that they felt better. Elderly patients over the age of 60 years were more likely to be prescribed a tricyclic than an SSRI and although there was no statistically significant association, more patients taking an SSRI had it prescribed for five months or more.

The majority of patients agreed antidepressants would relieve depression and that they were prepared to take them. However 32 (37%) had specific concerns about taking antidepressants with the prime concern being fear of addiction. 44 (51%) were uncertain whether antidepressants were addictive. Patients wanted all the options of treatment explained to them, but some were concerned that this does not happen at the moment whilst others were concerned that the GP was too busy and that patients 'feel that when I go and see my GP that he is too busy.'

Of potential methods to promote adherence, the use of written material to back up verbal information was the most popular with patients and health professionals. There was unanimous agreement among patients that it is appropriate for the GP to provide this information. This was confirmed by a number of health professionals who thought 'patients still have this underlying feeling that the doctor said it so it's OK.'

Guidelines are a method of supporting effective clinical practice and a specific target in the National Service Framework for Mental Health is the development of a local protocol for the management of depression by April 2001. Local guidelines for the management of depression have been developed which include specific recommendations from the study such as to book a double appointment to allow patients more time. The advantage of incorporating local research into local guidelines is that there is morel likely to be ownership and therefore adherence to them.