We studied the ability of psychiatric practitioners to recognize and treat major depression in standard clinical practice in Finland. A questionnaire with 18 items (including, e.g. physicians characteristics, two case reports and diagnostic and treatment proposals for both of them) was sent to 255 physicians in communal psychiatric outpatient care, 216 physicians responded (85%). Results suggest that diagnostic accuracy was good. Treatment proposals showed high sensitivity and lower specificity when the use of antidepressive medication was examined. This may reflect increased education concerning the illness and the effect of the new antidepressants, which are probably considered easier to initiate, or may be partly due to systematic error. Physicians characteristics determined neither diagnostic nor treatment decisions.