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September 5, 2012

Depression Treatment for Patients With Complex Conditions—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliation: Department of Veterans Affairs Medical Center, San Francisco, California (mary.whooley@ucsf.edu).

JAMA. 2012;308(9):860-861. doi:10.1001/jama.2012.9738

In Reply: Drs Karp and Whyte raise 2 important points regarding the management of depression in primary care settings. First, depressive symptoms can overlap with those of OSA. Therefore, in a patient with OSA, it is important to inquire about compliance with the CPAP device, verify proper mask fit, and consider modafinil if excessive daytime sleepiness persists despite appropriate therapy.

Second, patients with depression have a high prevalence of comorbid anxiety disorders, and screening with the 2-item Generalized Anxiety Disorder scale can improve case identification. Whether routine screening for anxiety disorders benefits primary care patients has not been determined. However, first-line therapies (cognitive behavioral therapy and selective serotonin reuptake inhibitors) are the same for both depression and anxiety disorders,1-3 so patients treated for major depressive disorder will usually receive therapy for both conditions.