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.

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Contact: Catherine Sherbourne
cathy_sherbourne@rand.org
Center for the Advancement of Health
5-May-2004