Primary Care Research

Antidepressants and therapy may be cost-effective for patients with medically unexplained symptoms

Individuals complaining of physical problems for which there is little or no disease explanation (somatization) make up 5 to 10 percent of primary care patients. These individuals, many of whom are depressed, often embark on a quest to find a disease that they fear but do not have. This typically results in numerous laboratory tests and consultations, as well as treatments of nonexistent conditions. Not only is this a costly enterprise, but physicians often ignore these patients' emotional distress, note Michigan State University researchers. They hypothesized that use of antidepressants and cognitive-behavioral therapy, combined with a focus on a strong provider-patient relationship, may be of some help to these patients.

The researchers randomized 206 HMO patients with medically unexplained symptoms to usual care or this multimodal approach (treatment). This reduced patient depression and improved satisfaction with providers, decreased physical disability, increased use of antidepressants, and reduced use of addicting agents such as painkillers. In addition, this treatment approach resulted in insignificantly higher care costs ($1,071) over the 1-year period for the treatment versus the usual care group and no significant difference in care costs ($341) in the year after the treatment. The treatment group also missed one less work day per month 6 months after the treatment, an insignificant improvement in productivity.

Given the other findings from this study, this approach may be cost-effective, suggest the researchers. The study was supported in part by the Agency for Healthcare Research and Quality (HS14206).

See "Costs of an intervention for primary care patients with medically unexplained symptoms: A randomized controlled trial," by Zhehui Luo, Ph.D., M.S., John Goddeeris, Ph.D., Joseph C. Gardiner, Ph.D., and Robert C. Smith, M.D., Sc.M., in the August 2007 Psychiatric Services 58(8), pp. 1079-1086.

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