Objective: To determine how primary care physicians treat patients wit
h major depression in the course of routine practice and the degree to
which such practice produces outcomes anticipated with interventions
recommended by the Agency for Health Care Policy and Research Depressi
on Guideline Panel. Design: Prospective cohort study. Settings: Academ
ically affiliated ambulatory family practice centers and internal medi
cine clinics in urban neighborhoods of Pittsburgh, Pa. Patients: Ninet
y-two patients who were seen in primary care practices and who met cri
teria for a current major depression as determined by the Diagnostic I
nterview Schedule and a psychiatrist's assessment. Intervention: Physi
cians were informed of the patient's psychiatric diagnosis, and were u
rged to treat it in whatever manner and for whatever duration they dee
med appropriate tie, with ''usual care''). Main Outcome Measures: The
treatments that were provided, the patients' clinical course, and the
relationship between the type of treatment and clinical course. Result
s: Health center records indicated that 67 patients (73%) received a d
epression-specific treatment in the 8 months following study entry, A
majority of the total cohort were prescribed an antidepressant drug. O
f the 92 patients, 18 (20%) were asymptomatic at 8 months (Hamilton Ra
ting Scale for Depression scare, less than or equal to 7), The treatme
nt pattern was not clearly related to the clinical course. Conclusions
: The recovery rates for the patients with major depression who were t
reated with usual care in routine primary care practices were lower th
an those anticipated from treatments consistent with the Agency for He
alth Care Policy and Research guidelines. Further studies of the careg
iving elements that influence the effectiveness of depression-specific
treatments of patients in primary cart settings are needed.