Depressive illness--the need for a paradigm shift in its understanding and management

Depression as a symptom and a disease has been recognized from antiquity. While numerous references to melancholia, illnesses of the heart broken, and delusions of guilt are found in Shakespearean literature, world literature, stories, and dramas the world over, yet the development of modern western medicine has by and large tended to ignore all things psychological in the process of disease recognition and understanding. Even the face of a depressed patient, so obvious to the initiated, is a rarely taught and recognized sign of ill health by non- psychiatrists. The long association of psychiatry with severe psychoses in the minds of medical teachers has dulled the sense of astuteness in the picking up of anxiety and depression. It has also dulled the medical profession into the delusion that mental illnesses do not occur in general hospitals. Thus the fairly large number of mental problems in every day clinical practice remains an area of darkness. In practice, the pick up rate of all mental illnesses in primary care remains very low at less than 5% of all mental illnesses while studies show that about 25% of all primary care patients have significant mental problems that necessitate their attendance in the primary care clinics.