Objectives To determine whether problem solving treatment combined with antidepressant medication is more effective than either treatment alone in the management of major depression in primary care. To assess the effectiveness of problem solving treatment when given by practice nurses compared with general practitioners when both have been trained in the technique.

Objective-To determine whether, in the treatment of major depression in primary care, a brief psychological treatment (problem solving) Results-At six and 12 weeks the difference in score on the Hamilton rating scale for depression between problem solving and placebo treatments was significant (5.3 (95% confidence interval 1-6 to 9.0) and 4-7 (0.4 to 9.0) respectively), but the difference between problem solving and amitriptyline was not significant (1-8 (-1l8 to 5.5) and 0 9 (-3.3 to 5.2) respectively). At 12 weeks 60%'/. (18/30) of patients given problem solving treatment had recovered on the Hamilton scale compared with 52% (16/31) given amitriptyline and 27% (8/30) given placebo. Patients were satisfied with problem solving treatment; all patients who completed treatment (28/30) rated the treatment as helpful or very helpful. The six sessions of problem solving treatment totalled a mean therapy time of31/, hours.Conclusions-As a treatment for major depression in primary care, problem solving treatment is effective, feasible, and acceptable to patients.

Physical health problems are common in SMI subjects. Many patients completed 2 years follow up suggesting that this format of programme is an acceptable option for SMI patients. Cardiovascular risk factors were significantly improved. Interventions such as the Well-being Support Programme should be made widely available to people with SMI.