Better treatment for depression
===============================

* Richard E. Hibbard

Thank you to Patrick for her recent editorial1 on depression. Her statement that “the fact that we don’t have widely accessible and effective treatments for depression is a serious problem” is an understatement. Canada is capable of doing much better.

The way forward is through:

*   a massive effort to make evidence-supported behavioural treatments accessible to all Canadians

*   better integration of primary care with mental health care

*   more research into strategies to improve behavioural treatment outcomes such as mindfulness to improve the outcomes of cognitive behavioural therapy

*   new models for delivery of mental health care such as the Mood Disorders Association of BC Psychiatric Urgent Care Program to replace the inefficient and costly private-practice model that so many psychiatrists use2

*   more research into why some individuals with depression drop out of treatment or do not respond (each individual with depression needs a thorough psychiatric assessment to identify comorbid conditions such as anxiety or personality disorder that contribute to drop out or treatment failure if not addressed)

*   boosting community programs.

The need is urgent and action is required at all levels: federally, provincially and locally.

## References

1.  Patrick K. Depression deserves better treatment. CMAJ 2014;186:1043.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTg2LzE0LzEwNDMiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTg3LzYvNDM5LjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  Remick RA, Araki Y, Bruce R, et al. The Mood Disorders Association of British Columbia Psychiatric Urgent Care Program: A preliminary evaluation of a suggested alternative model of outpatient psychiatric care. Can J Psychiatry 2014;59:220
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1177/070674371405900407&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=25007115&link_type=MED&atom=%2Fcmaj%2F187%2F6%2F439.1.atom)