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September 20, 2000

Screening for Depression in Primary Care—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(11):1379-1380. doi:10.1001/jama.284.11.1378

In Reply: Dr Schwenk asserts that depressed patients in primary care are different than those seen in psychiatric settings. Although I agree, this is only because many depressed patients seen by primary care physicians are unrecognized as such or have yet to be referred for psychiatric treatment. Data illustrate that nearly 50% of depressed patients seek help through a primary care physician.1 In addition, Schwenk comments that suicidal patients are rare in primary care. However, the undeniable trend in managed care is to place the primary care physician at the point of entry to the health care system where he or she determines the referral or treatment path of all patients, including those with psychiatric illness, often in just a few minutes.