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To the Editor: Dr Kessler and colleagues¹ were critical of nonpsychiatrists for what they perceived as our failure to meet evidence-based standards for the treatment of depression. While there is no doubt that we can all do better to treat patients with depression (including psychiatrists, who are less likely than primary care physicians to adequately treat patients with depression who have only mild symptoms),¹ this retrospective survey has a number of other limitations.

Most important, patients who choose to seek care from a psychiatrist implicitly acknowledge that they are depressed and would like help. It is therefore not surprising that these patients are more likely to adhere to a treatment plan. Although patients with depression in the primary care setting often present with fatigue or chronic pain or myriad other vague symptoms, most do not label themselves as depressed. While some accept the diagnosis of depression, many do not. I . . . [Full Text of this Article]

Mark H. Ebell, MD, MS
Department of Family Medicine
Michigan State University College of Human Medicine
East Lansing

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