Treatment of dysthymia and minor depression in primary care - A randomizedtrial in patients aged 18 to 59 years

OBJECTIVE We evaluated the effectiveness of paroxetine and Problem-Solving Treatment for Primary Care (PST-PC) for patients with minor depression or d ysthymia. STUDY DESIGN This was an 11-week randomized placebo-controlled trial conduc ted in primary care practices in 2 communities (Lebanon, NH, and Seattle, W ash). Paroxetine (n=80) or placebo (n=81) therapy was started at 10 mg per day and increased to a maximum 40 mg per day, or PST-PC was provided (n=80) . There were 6 scheduled visits for all treatment conditions. POPULATION We included a total of 241 primary care patients with minor depr ession (n=114) or dysthymia (n=127). Of these, 191 patients (79.3%) complet ed all treatment visits. OUTCOMES We measured depressive symptoms using the 20-item Hopkins Depressi on Scale (HSCL-D-20). Remission was scored on the Hamilton Depression Ratin g Scale (HDRS) as less than or equal to 6 at 11 weeks. We measured function al status with the physical health component (PHC) and mental health compon ent (MHC) of the 36-item Medical Outcomes Study Short Form. RESULTS All treatment conditions showed a significant decline in depressive symptoms over the Ii-week period. There were no significant differences be tween the interventions or by diagnosis. For dysthymia the remission rate f or paroxetine (80%) and PST-PC (57%) was significantly higher than for plac ebo (44%, P=.008). The remission rate was high for minor depression (64%) a nd similar for each treatment group, For the MHC there were significant out come differences related to baseline level for paroxetine compared with pla cebo, For the PHC there were no significant differences between the treatme nt groups. CONCLUSIONS For dysthymia, paroxetine and PST-PC improved remission compare d with placebo plus nonspecific clinical management. Results varied for the other outcomes measured. For minor depression, the 3 interventions were eq ually effective; general clinical management (watchful waiting) is an appro priate treatment option.