October 1996

Treating Major Depression in Primary Care PracticeEight-Month Clinical Outcomes

Author Affiliations

From the Departments of Psychiatry and Medicine, University of Pittsburgh School of Medicine (Drs Schulberg, Block, Scott, Rodriguez, Imber, Perel, and Lave and Ms Houck); Department of Family Medicine, The Western Pennsylvania Hospital, Pittsburgh (Dr Block and Mr Madonia); St Margaret Memorial Hospital Family Practice Residency, Pittsburgh (Dr Scott); and Department of Preventive Medicine, State University of New York at Stony Brook, School of Medicine (Dr Coulehan).

Arch Gen Psychiatry. 1996;53(10):913-919. doi:10.1001/archpsyc.1996.01830100061008

Background:  We studied whether standardized treatments of major depression whose efficacy was established with psychiatric patients are equally effective when provided to primary care patients, and whether standardized treatments are more effective than a primary care physician's usual care.

Methods:  A randomized controlled trial was conducted, in which primary care patients meeting DSM-III-R criteria for a current major depression were assigned to nortriptyline (n=91) or interpersonal psychotherapy (n=93) provided within well-structured parameters, or a physician's usual care (n=92). The main outcome measures were degree and rate of improvement in severity of depressive symptoms and proportion of patients recovered at 8 months.

Results:  Severity of depressive symptoms was reduced more rapidly and more effectively among patients randomized to pharmacotherapy or psychotherapy than among patients assigned to a physician's usual care. Among treatment completers, approximately 70% of patients participating in the full pharmacotherapy or psychotherapy protocol but only 20% of usual care patients were judged as recovered at 8 months.

Conclusions:  Pharmacotherapy and psychotherapy effectively treat major depression among primary care patients when provided within specific parameters and for the full acute and continuation phases. Treatment principles recommended by the Depression Guideline Panel of the Agency for Health Care Policy and Research are supported.