Status of minor depression or dysthymia in primary care following a randomized controlled treatment

This report describes the rates of recovery and remission from minor depres sion or dysthymia in primary care patients three months after completing a randomized controlled treatment trial. The subjects were primary care patie nts who received greater than or equal to4 treatment sessions with Problem- Solving Treatment, paroxetine, or placebo and who completed an independent assessment 3 months after the study (201 with minor depression, 229 with dy sthymia). The 17-item Hamilton Rating Scale for Depression (HAMD), semistru ctured questions about postintervention depression treatments, and baseline medical comorbidity, neuroticism, and social function were the primary mea sures. For minor depression 76% and for dysthymia 68% of subjects who were in remission at the end of the 11-week treatment trial were recovered (HAMD less than or equal to6) three months after the treatment trial. Of patient s who were not in remission at I I weeks, for minor depression 37% and for dysthymia 31% went on to achieve remission at 25 weeks. The majority of pat ients chose not to use antidepressants or psychotherapy after the trial. Pa tients with minor depression that had greater baseline social function and lower neuroticism scores were more likely to be recovered. For patients wit h minor depression, these findings suggest a need for some matching of cont inuation and maintenance treatment to patient characteristics rather than u niform. automatic treatment recommendations. Because of the chronic, relaps ing nature of dysthymia, practical improvements in encouraging effective co ntinuation and maintenance phases of treatment are indicated. (C) 2001 Else vier Science Inc. All rights reserved.