Treating Depression and Bipolar Disorder in Integrated Care Settings

Primary care clinics are the de facto treatment settings for patients with major depression and bipolar disorder. Primary care patients with mood disorders are more difficult to assess and treat than patients without such disorders, often have comorbid medical and psychiatric conditions, and require greater practice resources for optimal management. Because current treatment of mood disorder patients in primary care settings is often minimally adequate, changes in overall management strategies are needed to improve outcomes. This chapter describes pathways by which primary care providers can implement an integrated care and collaborative model likely to improve patient outcomes. It describes the epidemiology and costs of mood disorders, as well as basic pharmacologic and psychosocial approaches useful in primary care settings. Depressed patients who are refractory to treatment and patients with bipolar disorder are more complicated to manage and almost always require collaboration with a behavioral health specialist and a consulting psychiatrist.