Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Bruce and colleagues1 reported that, compared with usual care, presence
of a depression specialist in primary care practices resulted in reduced suicidal
ideation and a more favorable clinical course among elderly patients with
major and minor depression. I am concerned, however, that patients in the
intervention condition had access not only to a depression specialist, but
to free medication and psychotherapy. The patients who received routine care
had neither. Thus, it is not clear how much of the clinical effect was due
to the presence of the specialist, particularly as patients in the intervention
group were approximately 4 times more likely to receive any treatment than
those in routine care.
Coyne JC. Interventions for Treatment of Depression in Primary Care. JAMA. 2004;291(23):2814. doi:10.1001/jama.291.23.2814-a