Depressed primary care patients

Many depressed individuals are willing to accept medical but not mental health treatment. Schulberg and colleagues compared IPT to nortriptyline pharmacotherapy for depressed ambulatory medical patients in a primary-care setting (Schulberg & Scott, 1991; Schulberg et al., 1993). IPT was integrated into the routine of the primary-care center: for example, nurses took vital signs before each session, and if patients were medically hospitalized, IPT was continued in the hospital when possible.

Patients with current major depression (n = 276) were randomly assigned to IPT, nor-triptyline, or primary-care physicians' usual care. They received 16 weekly sessions followed by four monthly sessions of IPT (Schulberg et al., 1996). Depressive symptoms improved more rapidly with IPT or nortriptyline than in usual care. About 70% of treatment completers receiving nortriptyline or IPT recovered after 8 months, compared to 20% in usual care. This study had an odd design for treatment in the USA in bringing mental health treatment into medical clinics, but might inform treatment in the UK, where a greater proportion of antidepressant treatments are delivered in primary-care settings.

In the Schulberg et al. study, subjects with a lifetime history of comorbid panic disorder had a poor response across treatments compared to those with major depression alone (Brown et al., 1996). These predictive findings on comorbid panic disorder were corroborated by Frank et al. (2000a).

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