Primary Care Research

Even when primary care patients receive recommended treatment for their depression, nearly half remain depressed

Over half of depressed patients are treated in primary care. Yet, even when they receive recommended treatment for their depression, nearly half of them remain depressed, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08349). Nonresponse to depression treatment was higher in patients not working at baseline (59 percent vs. 42 percent of workers), in those with suicidal ideation, that is, those who thought about death a lot or considered committing suicide (54 percent vs. 46 percent of those without such ideation), and in those who had stopped taking their psychotropic medication early (58 percent compared with 42 percent of those who did not stop early).

Nonresponders also received more counseling and combination medications than responsive patients. This suggests that persistent depression may represent true treatment resistance and that doctors were searching for solutions, explains Cathy Sherbourne, Ph.D., of RAND. Dr. Sherbourne and her colleagues examined the sociodemographic and clinical characteristics of 542 depressed primary care patients who received treatment for depression that met at least minimal evidence-based standards. This included four or more specialty counseling visits over a 6-month period and/or use of antidepressant medication at or above the minimum dosage recommended by depression practice guidelines. The team compared treatment patterns and characteristics of those who remain depressed with those who recovered.

Of the 1,248 patients with followup data, 542 received at least minimally appropriate treatment. Of these, 442 received two courses of minimally appropriate treatment for two of three 6-month periods; 261 of these patients remained depressed, while 181 recovered. An additional 100 patients recovered and stayed recovered after receiving only one course of at least minimally appropriate treatment over the same interval.

See "Characteristics, treatment patterns, and outcomes of persistent depression despite treatment in primary care," by Dr. Sherbourne, Michael Schoenbaum, Ph.D., Kenneth B. Wells, M.D., M.P.H., and Thomas W. Croghan, M.D., in General Hospital Psychiatry 26, pp. 106-114, 2004

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