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December 8, 2004

Telephone Psychotherapy and Care Management for Depression

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(22):2720-2721. doi:10.1001/jama.292.22.2720-a

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.