Efficacy of Depression Tx in Primary Care Examined

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Efficacy of Depression Tx in Primary Care Examined
Efficacy of Depression Tx in Primary Care Examined

HealthDay News -- Two metaanalyses published examine current knowledge about depression treatment in primary care. The reports were published in the Annals of Family Medicine.

Klaus Linde, MD, from Technische Universität München in Germany, and colleagues conducted a systematic literature review to examine whether antidepressants are more effective than placebo in the primary care setting. Data were included from 66 studies with 15,161 patients.

Compared with placebo, tricyclic and tetracyclic antidepressants, selective serotonin reuptake inhibitors, a serotonin-noradrenaline reuptake inhibitor, and hypericum extracts were significantly superior (estimated odds ratios, 1.69 to 2.03), the researchers found. There were no statistically significant between-drug class differences.

In a second study, Linde and colleagues compared psychological treatments with usual care or placebo for treatment of depressed primary care patients. Data were reviewed from 30 studies with 5,159 patients.

The effect, measured in terms of the standardized mean difference at completion of treatment, was −0.30 for face-to-face cognitive behavioral therapy (CBT), −0.14 for face-to-face problem solving therapy, −0.24 for face-to-face interpersonal psychotherapy, and −0.28 for other face-to-face psychological interventions, compared with control.

The effect was −0.43 for remote therapist-led CBT, −0.56 for remote therapist-led problem-solving therapy, −0.40 for guided self-help CBT, and −0.27 for no or minimal contact CBT, compared with control, the researchers found.

In an accompanying editorial, Frank V. deGruy, MD, MSFM, of the department of family medicine at the University of Colorado School of Medicine in Denver, praises the two meta-analysis for summarizing current knowledge about the two most common forms of depression treatment, but pointed out that more work is needed to understand how make them work in primary care.

"We are becoming familiar with implementation issues in primary care as we attempt to transform our clinics to better manage patients' chronic diseases, to become patient-centered medical homes, to practice team-based care, or to continuously improve the quality of the care we render," deGruy wrote. "We are learning through hard experience that even effective interventions or simple guidelines are not necessarily easy to implement in a busy primary care practice."

He said competing demands and existing practice workflows and resources often limit primary care providers ability to practice evidence-based depression care, but said the metaanalyses "set the stage" for successful clinical improvements to occur.

References

  1. Linde K et al. Ann Fam Med. 2015; 13(1): 69-79.
  2. Linde K et al. Ann Fam Med. 2015; 13(1): 56-68.
  3. deGruy FV et al. Ann Fam Med. 2015; 13(1): 3-5.




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