upright evidence supports the effic...

upright evidence supports the efficacy of pharmacologic treatment and brief psychotherapy for depression, however the trials included primarily white, upper-middle-class populations. Miranda and colleagues considered whether guideline-based care for depression improves symptoms and function in abashed low-income minority women.

The researchers protectioned women in Women, Infants, and Children programs and Title X family-planning clinics. Of 532 black, 71 white, and 408 Latina patients meeting inclusion criteria and with a diagnosis of major depressive disorder, 427 complet a structur psychiatric diagnostic telephone interview. Of these, 267 complet a clinical interview and were randomized to antidepressant medications (n = 88) cognitive behavior therapy (n = 90) or referral to community mental health services (n = 89) with 117 black women 134 Latina women and 16 white women participating.

Antidepressant medication was given for six month with paroxetine used initially. If paroxetine had no weight despite dosage adjustment or was not tolerated, bupropion was used. Patients in the behavior therapy cluster were treated by experienced psychotherapists in eight weekly arrange or individual sessions. Women assigned to community health center referral were proposeed help with making their appointments and were contacted not seldom to encourage them to attend the intake appointment for care. During the six-month investigation patients were screened at monthly intervals with the Hamilton Depression Rating Scale (HDRS) and at baseline and three-month intervals for functional results and social function.

Patients in this studious mood were poor and mostly black and Latina, and many had experienceed rape or abuse. Fewer than undivided half were living with a partner or married, and the average patient had pair or more children. Of the women tendered community referral, 74 (83 percent) failed to attend equal one session, and only eight (9 percent) attended four or more sessions. Of the women randomized to medication, 67 (76 percent) received nine or more weeks of medication, and 40 (45 percent) received guideline-concordant medication for 24 or more weeks. Of the patients randomized to behavior therapy, 48 (53 percent) received four or more sessions, and 32 (36 percent) received six or more sessions.

According to the HDR women who received medication experienced a significant decrease in depressive symptoms (P < 001) as did women participating in behavior therapy (P = 006) when compared with the community referral cluster Medication, but not behavior therapy, significantly improved instrumental part function, and both treatments improved social function compared with community referral. by dint of month 6, 44.4 percent of the medication assign places to 32.2 percent of the behavior therapy cluster and 28.1 percent of the community referral cluster had achieved HDRS scores of 7 or les Further analyses replicated the comes in the medication group, moreover results showed less benefit in the behavior therapy cluster compared with the referral group

It is likely that outreach, transportation, and child care for the intervention clusters enhanced access to treatment. This cogitation showed that without this support, women were unlikely to use resources that were available to them. Evidence-based treatments appear to be effective in minority women if they are given support to domineer over barriers to care. Medication interventions may be more effective in this population than psychotherapy interventions.

Miranda J et al. Treating depression in predominantly low-income young minority women A randomized controll trial. JAMA July 2 2003;290:57-65

COPYRIGHT 2004 American Academy of Family Physicians

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