A questionnaire-based management algorithm for major depressive disorder in primary care is feasible to implement, though attrition from treatment is high. Among 25,000 patients in primary care clinics in a large metropolitan area, 4,325 (17%) screened positive for depression with 2,426 having a clinician-diagnosed depressive disorder. Of the 2,160 patients who had 18 weeks of follow-up care, 65% were treated with medication. Remission, defined as a PHQ-9 score of less than five, was more common in patients who experienced three or more follow-up visits. Of those who returned for three or more visits, 41.7% achieved remission. However, more than one-half of those diagnosed did not return for any follow-up care. The findings of this study suggest that patients suffering from depression can be successfully treated using measurement-based care within the primary care setting, and stronger emphasis on patient education and other approaches to reduce attrition may be needed for patients who fail to return for follow-up care.
A Structured Approach to Detecting and Treating Depression in Primary Care
Madhukar Trivedi, MD, et al
University of Texas Southwestern Medical Center, Dallas