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Br J Gen Pract. 2007 July 1; 57(540): 582.
PMCID: PMC2099648

Depression as chronic disease

Chris Burton, Senior Research Fellow
University of Edinburgh, Community Health Sciences: General Practice Section. E-mail:
Margaret Maxwell, Senior Research Fellow

Whether they intend it or not, Walters and Tylee's1 argument that depression needs a chronic disease model (CDM), conjures up a vision of another contractual recall of patients in order to go through an exercise in superficial questioning and box ticking.

What Chew Graham et al,2 and others cited by the authors, studied is better thought of in the UK as a collaborative care model, in which intensive (5–10 sessions) personal care is offered over months (but not the years that the CDM implies). Such successful models typically offer choices to patients of drug and non-drug treatments, such as problem solving which are at odds with the simple biomedical conceptualisation of depression as a brain disorder, but harder to deliver with limited resources.

Walters and Tylee point out the failure of current methods of treatment for depression, yet imply that more or greater intensity of the same is required. Given the relatively poor response to antidepressants over placebo, it is difficult to see how more (medical management) could be better in the context of primary care defined depressive disorders.

Depression is not the same as diabetes or asthma, in terms of its daily impact and the personal and social implications of the diagnosis. One of us has demonstrated the moral dilemma facing women in accepting help for depression, and in particular shown that in order to be acceptable, such interventions needed to be seen as short term and temporary.3

Patients with difficult lives meeting current conceptualisations of depression may well benefit from longitudinal care, but as Heath points out, human continuity easily becomes lost when medicine adopts disease based management.4 Such a de-humanising approach is in direct opposition to the approach expressed in Chew Graham's study: to ‘re-humanise’ people with depression.


1. Tylee A, Walters P. We need a chronic disease management model for depression in primary care. Br J Gen Pract. 2007;57:348–350. [PMC free article] [PubMed]
2. Chew-Graham CA, Lovell K, Roberts C, et al. A randomised controlled trial to test the feasibility of a collaborative care model for the management of depression in older people. Br J Gen Pract. 2007;57:364–370. [PMC free article] [PubMed]
3. Maxwell M. Women's and doctors' accounts of their experiences of depression in primary care: the influence of social and moral reasoning on patients' and doctors' decisions. Chronic Illn. 2005;1(1):61–71. [PubMed]
4. Heath I, Nessa J. Objectification of physicians and loss of therapeutic power. Lancet. 2007;369(9565):886–888. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners