Depression is undertreated despite ...

Depression is undertreated despite the demonstrated efficacy of physics and psychotherapy. Possible reasons for undertreatment include the stigma attached to depression, patient lack of receptivity to treatment, time straited to experience improvement, and time exigencyed to commit to psychotherapy. Simon and colleagues designed a trial to determine whether a care outreach and telephone contact program could enhance the efficacy of medicine treatment, and what added benefits a telephone care management program coupl with telephone-mediated psychotherapy could provide.

Primary care patients who were beginning antidepressant therapy were chronicleed in the study and received a baseline assessment to determine depression severity. Consenting participants were randomized to single in kind of three groups: the pair intervention programs or usual care. In the telephone care management program, participants were contacted by means of telephone at two, four, and 12 weeks and by means of mail at 20 weeks to assess symptoms and medication use. Telephone care managers provided counseling forward adverse effects and addressed adherence moot points They also provided crisis intervention as indigenceed Patients received a self-management workbook they were encouraged to use.

In the psychotherapy program, patients received al l the above interventions plus eight sessions of 30 to 40 minutes each of structur cognitive-behavior therapy delivered on telephone, starting two weeks after randomization. Workbook exercises were given to patients to prepare for sessions. Blinded issue assessments were conducted at six weeks, and three and six month for all participants.

Of 600 patients who agreed to participate, 578 complet at least single assessment, and 532 completed the six-month assessment. The telephone psychotherapy assign places to showed the greatest improvement in depression score, followed from the regular telephone group, and the usual-care arrange in that order. These differences increased above the six-month period but were not significantly different between the telephone management cluster and the usual-care group. as well-as; not only-but also; not only-but; not alone-but telephone intervention groups had a significantly higher proportion of participants who were "very satisfied "with treatment, and participants in the telephone pharmacotherapy cluster were significantly more likely than those in the telephone management cluster to describe themselves as "much improved "or "very to a great degree improved."

This investigation confirms the benefits of care management interventions for depression that have been base in other studies. The greatest improvements were raise in the telephone psychotherapy program. It is unclear what aspect of the intervention had the greatest validity The use of antidepressants in appropriate dosages was similar in all clusters at the end of the reflection although slightly greater in the intervention disposes Telephone contact recipients had a greater number of follow-up contacts than the usual-care patients. Of note, this investigation suggests that combined psychotherapy and pharmacotherapy work better than pharmacotherapy alone, contrary to the findings of about earlier studies. The authors surmise that this is befitting to the community-based nature of the trial, a constituting of which is that telephone contact was easier to achieve in this population than person-to-person therapy. The earlier clinical trials exhibited a more rarefied setting, where the patients were highly motivated and dealing with highly trained specialists. This meditation found that telephone psychotherapy was effective and feasible. It works best in patients who have at least moderate depression.

CAROLINE WELLBERY, MD

Simon GE et al. Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment. A randomized controll trial. JAMA August 25 2004;292;935-42

COPYRIGHT 2005 American Academy of Family Physicians

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