In the present study, process quality in outpatient depression care was documented by general practitioners and specialists in psychiatry. Opportunities to improve inpatient treatment were identified by comparing current physicians' treatment procedures with guideline recommendations and, furthermore, by evaluating treatment outcomes from the patients' perspective. Data of 350 depressed outpatients were collected by 43 GPs and 23 specialists in psychiatry in three study regions (Rhineland, South Baden and Munich). Data reflected psychopathology, diagnostic assessment, investigation of suicidal intentions as well as somatic and psychotherapeutic measures at the first visit. Additionally, change in depression symptoms after six to eight weeks by means of self-rating (n = 165) and expert rating (n = 70) was measured. The study shows that the GPs and, to a lesser extent, the specialists, still fail to orient themselves towards guideline recommendations regarding assessment, therapy and referral in depression care. These findings seem to be reflected in insufficient self rated treatment outcome: one half of the patients reported a reduction in depression symptoms, the other half of patients reported stagnation or even progression. Expert ratings of treatment courses were more positive. The results indicate a considerable need for guideline training and improvement of networking and co-operation between GPs and specialists as well as between inpatient and outpatient settings.