A randomized trial of relapse prevention of depression in primary care.

Abstract

BACKGROUND:

Despite high rates of relapse and recurrence, few primary care patients with recurrent or chronic depression are receiving continuation and maintenance-phase treatment. We hypothesized that a relapse prevention intervention would improve adherence to antidepressant medication and improve depression outcomes in high-risk patients compared with usual primary care.

METHODS:

Three hundred eighty-six patients with recurrent major depression or dysthymia who had largely recovered after 8 weeks of antidepressant treatment by their primary care physicians were randomized to a relapse prevention program (n = 194) or usual primary care (n = 192). Patients in the intervention group received 2 primary care visits with a depression specialist and 3 telephone visits over a 1-year period aimed at enhancing adherence to antidepressant medication, recognition of prodromal symptoms, monitoring of symptoms, and development of a written relapse prevention plan. Follow-up assessments were completed at 3, 6, 9, and 12 months by a telephone survey team blinded to randomization status.

RESULTS:

Those in the intervention group had significantly greater adherence to adequate dosage of antidepressant medication for 90 days or more within the first and second 6-month periods and were significantly more likely to refill medication prescriptions during the 12-month follow-up compared with usual care controls. Intervention patients had significantly fewer depressive symptoms, but not fewer episodes of relapse/recurrence over the 12-month follow-up period.

CONCLUSIONS:

A relapse prevention program targeted to primary care patients with a high risk of relapse/recurrence who had largely recovered after antidepressant treatment significantly improved antidepressant adherence and depressive symptom outcomes.

• Authors: W Katon, C Rutter, E J Ludman, M Von Korff, E Lin, G Simon, T Bush, E Walker, J Unützer
• Journal: Archives of general psychiatry (Arch Gen Psychiatry) Vol. 58 Issue 3 Pg. 241-7 (Mar 2001) ISSN: 0003-990X [Print] United States
• PMID: 11231831 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antidepressive Agents

Topics

• Adolescent
• Adult
• Aged
• Antidepressive Agents (administration & dosage, therapeutic use)
• Depressive Disorder (diagnosis, drug therapy, prevention & control)
• Drug Administration Schedule
• Drug Prescriptions (statistics & numerical data)
• Female
• Health Maintenance Organizations (statistics & numerical data)
• Humans
• Male
• Middle Aged
• Patient Compliance
• Patient Education as Topic
• Phenylketonurias
• Primary Health Care (statistics & numerical data)
• Secondary Prevention
• Severity of Illness Index
• Treatment Outcome