I am appalled that Ray Rowden refers to depression and anxiety as 'common madness' (news, pages 6-7, 14 October).

Many of my colleagues, and myself, are working hard to improve the care of people suffering these distressing and disabling conditions at primary care level, and to reduce the associated stigma.

We already face enormous problems in persuading commissioners of training to take the needs of primary care doctors and nurses seriously.

Managers' understanding of mental health at primary care level is woefully inadequate - but the demand from practitioners for better training is growing.

HSJ, which is supposed to inform managers in the NHS, does patients a grave disservice by perpetuating unhelpful attitudes.

Elizabeth Armstrong Executive director, Depression Care Training Centre Chair, National Depression Campaign Member, Primary Care Mental Health Education Executive