For many, depression persists after routine treatment

Half of patients treated for depression in primary care facilities during a recent study still suffered from the condition 18 to 24 months later, according to recent research.

Patients who were unemployed, had suicidal thoughts at the beginning of the study and who stopped taking antidepressant medication on their own, before their doctor told them to quit the treatment were more likely to suffer persistent depression symptoms than those who recovered from depression over the course of the study, according to Catherine Sherbourne, Ph.D., of RAND and colleagues.

Their findings are published in the General Hospital Psychiatry.

Those with persistent depression were also the most likely to pursue aggressive therapy that combined medication and counseling sessions “suggesting that the persistent depression was not because of less intensive treatment and may represent true treatment resistance,” Sherbourne says.

Researchers and physicians need to learn more about the track record of depression treatment in primary care, since primary care settings like clinics and hospitals treat more than half of all depressed patients in the United States, the authors say.

“Relative to patients who recovered, patients with poor treatment responses continued to use both general medical and mental health specialty services of all types, placing a burden on themselves, friends and family and on the health care system,” Sherbourne says.

Sherbourne and colleagues followed the treatment outcomes for 1,248 people diagnosed with depression at 46 primary care clinics nationwide. Of this group, less than half received “minimally appropriate treatment” for their depression, defined as four or more special counseling sessions during six months or the use of approved antidepressant drugs for at least two months. Patients in the study could choose whether to receive therapy only, drugs only, a combination of the two or no treatment at all.

Only 442 patients received at least two six-month sessions of treatment. Of those patients, 261 people remained depressed and 181 had recovered from depression 18 to 24 months after the study started.

Patients with persistent depression were more likely than those who recovered to report side effects from their medication, to be in worse mental and physical health at the start of the study and to have sought prior treatment for depression. Patients who recovered were more likely to prefer counseling at the start of the study.

Those with persistent depression were also more likely to say they received less care from their doctors than they wanted. When asked why they did not seek further help, many said “they didn’t think they could be helped” or said they were too embarrassed or afraid to bring up the issue with their health care provider, Sherbourne says.

The study was supported by Eli Lilly and Co., which manufactures the antidepressant Prozac, the Agency for Healthcare Research and Quality, the National Institute of Mental Health and the John D. and Catherine T. MacArthur Foundation (which also supports the Health Behavior News Service).

Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Interviews: Contact Catherine Sherbourne at cathy_sherbourne@rand.org.
General Hospital Psychiatry: Don R. Lipsitt, M.D., at (617) 661-3544.