It is estimated that only 50% of those in the United States who suffer from major depression seek treatment. Additionally treatment received is often very inadequate. In the United States most drug treatment for depression takes place in primary care medical settings. Eighty-five percent of prescriptions written in the United States for antidepressants are written by physicians and nurses that do not have specialty training in psychiatry. This is due in large part to managed care’s efforts to cut costs by having the majority of psychiatric treatment take place in primary care settings. Treatment outcomes in primary care medical settings are poor largely due to the lack of adequate follow-up.