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In Reply: Dr Dietrich and colleagues and Dr Ebell note that patients with depression in the primary care setting are much less likely than those in the specialty care setting to accept a diagnosis of depression and to comply with treatment regimens. We agree that this difference may be an important factor in the lower rate of adequacy of treatment among primary care patients than specialty sector patients with depression. It is apparently not an overwhelming factor, however, as a number of trials have found that detection and treatment of depression in primary care can be improved significantly by implementing cost-effective disease management programs.^1-2

Dietrich et al comment on our statement that improved treatment of depression will require "redirection of patient help-seeking to sectors where guideline concordant care can be provided." We did not mean to refer to primary care treatment, but rather to the 9.2% of individuals with major . . . [Full Text of this Article]

Ronald C. Kessler, PhD; Olga Demler, MS; Robert Jin, MA; Ellen E. Walters, MS
Department of Health Care Policy
Harvard Medical School
Boston, Mass

Patricia Berglund, MBA
Institute for Social Research
University of Michigan
Ann Arbor

Doreen Koretz, PhD
Division of Mental Disorders

Kathleen R. Merikangas, PhD
Intramural Research Program
National Institutes of Health
Rockville, Md

A. John Rush, MD
Department of Psychiatry
University of Texas Southwestern Medical Center
Dallas

Philip S. Wang, MD, DrPH
Brigham and Women's Hospital
Harvard Medical School

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