Objective: In the UK, the use of protocols for the management of depression is set to increase in response to the National Service Framework for Mental Health. To date, there has been little evaluation of the utility of such protocols in primary care. This paper describes a naturalistic, observational study of the level of adherence and concordance by general practitioners (GPs) and patients respectively to a simple 3-step protocol for the pharmacological treatment of major depression. Methods: GPs treating major depressed patients were asked to follow a 3-step, 18-week protocol for acute phase pharmacological treatment; the protocol representing a systematised approach to a treatment-as-usual model. Results: There was full adherence and concordance with the protocol in 14 (13%) of 104 cases. Patient non-attendance for a visit was the single most common reason for protocol violation. Conclusion: These results give cause for serious reflection on the energies that are being expended nation-wide to develop depression treatment protocols under The National Service Framework for Mental Health. Indeed, it is difficult to see how such protocols can have any utility if, in the real world, non-adherence is the rule rather than the exception.