Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: In the study by Dr Simon and
colleagues,1 patients initiating antidepressant
treatment were randomly assigned to receive telephone care management alone,
telephone care management with telephone psychotherapy, or usual care. I am
concerned that the group receiving usual care was characterized by no contact
until 6 weeks had elapsed since the start of medication. Following the initiation
of antidepressants there may be an increased risk of suicidal ideation, particularly
during the first month.2 The United States
Department of Health and Human Services guideline for treatment of major depression
in primary care recommends that patients check in every 1 to 2 weeks for the
initial 6 to 8 weeks of medication treatment.3 It
therefore appears that the usual care in this study setting was suboptimal.
The superior efficacy of the telephone interventions in this study may simply
be the result of regular follow-up ensuring compliance and timely assessment
of response to treatment.
Tanvetyanon T. Telephone Psychotherapy and Care Management for Depression. JAMA. 2004;292(22):2720-2721. doi:10.1001/jama.292.22.2720-a