Depression in the Primary Care Setting

Screening for depression and suicidality is important in primary care. Major depressive disorder should be distinguished from bipolar disorder (for which treatment is different). Psychotherapy (for mild depression) and pharmacotherapy are effective therapies.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Dr. Zarate reports holding patents (PCT/US2007/06898; 8,785,500; 9,539,220; and 9,592,207) on intranasal administration of ketamine to treat depression, patents (PCT/US2012/060256; 9,867,830; and 6296985) on the use of (2R, 6R)-hydroxynorketamine, (S)-dehydroxynorketamine, and other stereoisomeric dehydro and hydroxylated metabolites of (R,S)-ketamine in the treatment of depression and neuropathic pain, pending patent (PCT/US2017/024238) on methods of using (2R, 6R)-hydroxynorketamine and (2S, 6S)-hydroxynorketamine in the treatment of depression, anxiety, anhedonia, fatigue, suicidal ideation, and post-traumatic stress disorder, and pending patent (PCT/US2017/024241) on crystal forms and methods of synthesis of (2R, 6R)-hydroxynorketamine and (2S, 6S)-hydroxynorketamine. No other potential conflict of interest relevant to this article was reported.

We thank the 7SE research unit and staff for their support and Ioline Henter of the National Institute of Mental Health for invaluable editorial assistance with an earlier version of the manuscript.

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