Outcomes of “Inadequate” antidepressant treatment |
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Authors: | Dr Gregory E Simon MD MPH Elizabeth H B Lin MD MPH Wayne Katon MD Kathleen Saunders Michael VonKorff ScD Edward Walker MD Terry Bush PhD Patricia Robinson PhD |
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Institution: | (1) the Center for Health Studies, Group Health Cooperative, Seattle, Washington;(2) the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington |
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Abstract: | OBJECTIVE: To examine outcomes of primary care patients receiving low levels of antidepressant treatment.
DESIGN: Cohort study comparing patients receiving antidepressant treatment within and below the recommended dosing range.
SETTING: Primary care clinics of a staff-model health maintenance organization.
PATIENTS: Primary care patients initiating antidepressant treatment for depression.
MEASUREMENTS AND MAIN RESULTS: Of 88 patients beginning antidepressant treatment, 49 (56%) used “adequate” doses for 30 days or more. Likelihood of “adequate”
pharmacotherapy was not related to patient age, gender, medical comorbidity, or baseline depression severity. All the patients
showed substantial clinical improvement after four months. Compared with those using “adequate” pharmacotherapy, the patients
receiving low-intensity treatment had lower likelihood of clinical response (64% vs 84%; chi-square=4.44; df=1; p=0.035).
At four months, however, those receiving low-intensity and those receiving higher-intensity treatment did not differ significantly
in either the score on the 20-item Symptom Checklist depression scale (18.91 and 15.72, respectively; F=1.45; df=1, 86; p=0.23)
or the proportion with persistence of major depression (10% and 4%, respectively; chi-square=1.30; df=1; p=0.25). A replication
sample of 157 patients (assessed only at baseline and four months) yielded similar results.
CONCLUSIONS: While the patients receiving recommended levels of pharmacotherapy showed somewhat higher improvement rates, many of the
patients receiving “inadequate” treatment experienced good short-term outcomes. Efforts to increase the intensity of depression
treatment in primary care should focus on the subgroup of patients who fail to respond to initial treatment.
Supported by NIMH grants #MH41739 and #51338. |
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Keywords: | depression treatment primary care antidepressants outcomes |
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