General Practitioners’ Choices and Their Determinants When Starting Treatment for Major Depression: A Cross Sectional, Randomized Case-Vignette Survey.

General practitioners’ choices and their determinants when starting treatment for major depression: a cross sectional, randomized case-vignette survey.

Filed under: Depression Treatment

PLoS One. 2012; 7(12): e52429
Dumesnil H, Cortaredona S, Verdoux H, Sebbah R, Paraponaris A, Verger P

In developed countries, primary care physicians manage most patients with depression. Relatively few studies allow a comprehensive assessment of the decisions these doctors make in these cases and the factors associated with these decisions. We studied how general practitioners (GPs) manage the acute phase of a new episode of non-comorbid major depression (MD) and the factors associated with their decisions.In this cross-sectional telephone survey, professional investigators interviewed an existing panel of randomly selected GPs (1249/1431, response rate: 87.3%). We used case-vignettes about new MD episodes in 8 versions differing by patient gender and socioeconomic status (blue/white collar) and disease intensity (mild/severe). GPs were randomized to receive one of these 8 versions. Overall, 82.6% chose pharmacotherapy; among them GPs chose either an antidepressant (79.8%) or an anxiolytic/hypnotic alone (18.5%). They rarely recommended referral for psychotherapy alone, regardless of severity, but 38.2% chose it in combination with pharmacotherapy. Antidepressant prescription was associated with severity of depression (OR?=?1.74; 95%CI?=?1.33-2.27), patient gender (female, OR?=?0.75; 95%CI?=?0.58-0.98), GP personal characteristics (e.g. history of antidepressant treatment: OR?=?2.31; 95%CI?=?1.41-3.81) and GP belief that antidepressants are overprescribed in France (OR?=?0.63; 95%CI?=?0.48-0.82). The combination of antidepressants and psychotherapy was associated with severity of depression (OR?=?1.82; 95%CI?=?1.31-2.52), patient’s white-collar status (OR?=?1.58; 95%CI?=?1.14-2.18), and GPs’ dissatisfaction with cooperation with mental health specialists (OR?=?0.63; 95%CI?=?0.45-0.89). These choices were not associated with either GPs’ professional characteristics or psychiatrist density in the GP’s practice areas.GPs’ choices for treating severe MD complied with clinical guidelines better than those for mild MD; GPs rarely recommended psychotherapy alone but rather as a complement to pharmacotherapy. Their decisions were mainly influenced by personal life experience and attitudes regarding treatment more than by professional characteristics. These results call into question the methods and content of continuing medical education in France about MD management.
HubMed – depression

Disability in patients consulting for anxiety or mood disorders in primary care: response to antidepressant treatment.

Filed under: Depression Treatment

Neuropsychiatr Dis Treat. 2012; 8: 605-14
Gérard A, Liard F, Crochard A, Goni S, Millet B

The primary objective of this prospective observational study was to evaluate changes in self-reported disability in patients with anxiety or mood disorders 3 months after initiating antidepressant treatment.This study included 8396 patients consulting 2433 general practitioners in France for a major mood episode, generalized anxiety disorder, social anxiety disorder, panic disorder, or obsessive-compulsive disorder. Treatment was initiated with the antidepressant that the physician considered appropriate. Patients were evaluated with the Sheehan Disability Scale (SDS), Hospital Anxiety and Depression Scale, and Clinical Global Impression-Severity (CGI-S) at baseline and after 6 and 12 weeks.At 12 weeks, 6617 patients (78.8%) were evaluable. At inclusion, the mean SDS subscores were 6.5 ± 2.2 on the work/school activities dimension, 6.8 ± 1.9 on the social activities dimension, and 6.5 ± 2.0 on the family life dimension. At the 12-week follow-up visit, the mean change in score on these three dimensions was -3.9 ± 2.6, -4.2 ± 2.5, and -4.0 ± 2.5, respectively. At the 12-week follow-up visit, 90.0% of patients were responders (defined as patients whose SDS dimension scores decreased by at least one point) on the work/school SDS subscores; 92.8% were responders on the social life SDS subscores, and 91.1% were responders on family life/home responsibilities SDS subscores. Functional remission (defined as an SDS subscore of 0 at study end) rates were 18.0% for the work/school dimension, 16.8% for the social activities dimension, and 19.5% for the family life dimension. Using a cutoff of ?2, remission rates were 56.8%, 55.0%, and 58.0%, respectively. Improvements in self-rated disability were correlated with improvements in symptoms measured with clinician-rated CGI-S.Patients consulting for anxiety or mood disorders report significant disability, which can be effectively reduced by antidepressant treatment.
HubMed – depression

Risk factors for drug nonadherence in antidepressant-treated patients and implications of pharmacist adherence instructions for adherence improvement.

Filed under: Depression Treatment

Patient Prefer Adherence. 2012; 6: 863-9
Murata A, Kanbayashi T, Shimizu T, Miura M

The aim of this study was to determine the characteristics of drug adherence in antidepressant-treated versus antidepressant-naïve patients using Drug Attitude Inventory (DAI)-10 scores for nonadherence, to examine the contribution of patient variables such as age, gender, education, prescription contents, side effects, and type of depression (melancholic, nonmelancholic, bipolar) to the reported DAI-10 score, and to examine the efficacy of pharmacist adherence instruction on adherence with antidepressant therapy.The subjects were 71 antidepressant-treated inpatients (17 with melancholic depression, 35 with nonmelancholic depression, and 19 with bipolar depression) and 80 antidepressant-naïve inpatients. In the antidepressant-treated patients, self-management of drug intake and pharmacist adherence instruction was initiated after depressive symptoms were in remission, and pharmacist adherence instruction was conducted until the day of discharge.There were no significant differences in baseline characteristics between antidepressant-naïve and antidepressant-treated patients. In antidepressant-treated patients, the mean DAI-10 total score was significantly lower and awareness of side effects was significantly higher than in antidepressant-naïve patients who have never taken antidepressants, nor been referred to psychiatry services (according to pharmacist interviews and medical records). On the first day of self-management of drug intake, the DAI-10 total score in patients with melancholic and bipolar depression was significantly lower than that in patients with nonmelancholic depression. On the day of discharge, there was a significant improvement of DAI-10 total score in all antidepressant-treated patients, and the DAI-10 total score in patients with melancholic depression was significantly lower than that in patients with nonmelancholic depression. The limitation of the study was the small sample size and the fact that we followed only acute phase inpatients. However, the findings seem particularly robust in view of this.Risk factors for nonadherence included side effects of antidepressant treatment and type of depression. The results presented here suggest that patients with melancholic depression may be more vulnerable to nonadherence, and that pharmacist adherence instruction may improve nonadherence in antidepressant-treated patients according to type of depression.
HubMed – depression

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