In October 1995, at Psychiatry Grand Rounds, Dr Frederick Goodwin discussed a 47-year-old man with long-standing depression, treated with several courses of psychotherapy and short courses of a number of antidepressant medications without much success.1 The patient's care was further complicated by obesity and type II diabetes mellitus. Dr Goodwin highlighted the role of the primary care doctor in managing mild to moderate depression, proposing a coordinated, sequential approach that integrates psychotherapy and pharmacological therapy. He advocated the use of short-term cognitive and behavioral techniques, coupled with medications used singly or in combination.
Mr N, THE PATIENT:
Looking back over the past months, in some respects I have been almost totally nonfunctional and denying many things, while in other parts of my life I have been fine. For everything, with all my juggling, there has just been too little time, and now the bills are piling up. But it basically