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Editor's Correspondence
April 26, 1999

Generalist and Specialty Care

Arch Intern Med. 1999;159(8):884. doi:

In reply

Schwenk cites his own data on family physicians in Southeastern Michigan to claim that primary care patients with depression differ from those followed up by psychiatrists, as I noted in my review. I also agree that many patients with mild to moderate depression will improve, at least temporarily, without treatment. However, his conclusion that accurate diagnosis and treatment of primary care patients with depression does not improve outcomes is weakened by the many limitations he notes in his studies and by many works cited in my review. And, while he describes the use of research-based diagnostic criteria, he employed them in his cited articles. The important points are that many physicians, regardless of specialty, underdiagnose depression, and that even when detected, depression is inadequately or inappropriately treated. These deficits can be corrected by patient and provider education, improvements in access to care and insurance coverage, and enhanced cooperation between generalists and specialists.