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.
