background Little research has been done into the applicability of guidelines in general psychiatric practice.
aim To determine the applicability of a general guideline regarding the biological treatment of depression in a large institution for mental health care.
method Psychiatrists at the Gelderse Roos (an institution for mental health care) formed small focus groups in which they discussed in the course of a year to what extent actual treatment had deviated from the guideline and the reasons for these deviations. At the end of the year a postal
survey was conducted with regard to the use and validity of the guideline.
results Respondents listed numerous reasons for deviating from the guideline: some were patient-related (e.g. age, race and symptoms), some were context-related (e.g. previous treatment, patients'and doctors' preferences for non-biological interventions). In spite of these deviations psychiatrists found the guideline helpful.
conclusion A general guideline regarding the biological treatment of depression seems to have only limited applicability in a general psychiatric practice. Possible ways of dealing with this situation in the future are discussed.