Low-intensity treatment of depression in primary care: Is it problematic?

The aim of this study was to examine patterns of cave and outcomes of depre ssed patients tinder primary cave during acute phase treatment. A cohort of depressed patients was assessed 6-8 weeks after starting pharmacotherapy i n four large primary care clinics in a health maintenance organization. The se patients (n = 1671) were receiving antidepressant treatment for a new ep isode of depression. To calculate main outcome measures, Structured Clinica l Interview for Depression evaluated prior history and current depression s tatus. Visit and pharmacy refill data described use of health services and antidepressant medication. Six to eight weeks after starting antidepressant therapy, 33.2% of patients had 0-3 depressive symptoms and no prior histor y of depression, an additional 42.3% also reported 0-3 symptoms brit were a t high risk of relapse, and 24.5% were persistently depressed with 4 or mor e depressive symptoms. In the initial 6 weeks of treatment, these three gro ups showed similar use of antidepressant medication and health services. Ab out 50% in each group had no follow-up visit for depression and 32%-42% had not refilled their antidepressant prescription. In general, depressed pati ents under primary cave obtained low-intensity pharmacotherapy and inconsis tent follow-up visits during initial acute phase treatment. Six weeks after starting antidepressant medicine, many were still symptomatic or recovered but had a high risk of depression relapse. Patients with unfavorable outco mes did not receive more intensive management than the one-third who had fa vorable outcomes. (C) 2000 Elsevier Science Inc.