Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol.
Primary Care Research Group, University of Exeter Medical School, Exeter.
Br J Gen Pract. 2018 Oct;68(675):e673-e681. doi: 10.3399/bjgp18X699053.
Non-response to antidepressant medication is common in primary care. Little is known about how GPs manage patients with depression that does not respond to medication.
To describe usual care for primary care patients with treatment-resistant depression (TRD).
Mixed-methods study using data from a UK primary care multicentre randomised controlled trial.
In total, 235 patients with TRD randomised to continue with usual GP care were followed up at 3-month intervals for a year. Self-report data were collected on antidepressant medication, number of GP visits, and other treatments received. In addition, 14 semi-structured face-to-face interviews were conducted with a purposive sample after the 6-month follow-up and analysed thematically.
Most patients continued on the same dose of a single antidepressant between baseline and 3 months ( = 147/186 at 3 months, 79% (95% confidence interval [CI] = 73 to 85%)). Figures were similar for later follow-ups (for example, 9-12 months: 72% (95% CI = 63 to 79%). Medication changes (increasing dose; switching to a different antidepressant; adding a second antidepressant) were uncommon. Participants described usual care mainly as taking antidepressants, with consultations focused on other (physical) health concerns. Few accessed other treatments or were referred to secondary care.
Usual care in patients with TRD mainly entailed taking antidepressants, and medication changes were uncommon. The high prevalence of physical and psychological comorbidity means that, when these patients consult, their depression may not be discussed. Strategies are needed to ensure the active management of this large group of patients whose depression does not respond to antidepressant medication.
在初级保健中，抗抑郁药物治疗无反应很常见。对于药物治疗无反应的抑郁症患者，全科医生如何管理，我们知之甚少。
描述对药物治疗抵抗性抑郁症（TRD）的初级保健患者的常规治疗。
使用来自英国初级保健多中心随机对照试验的数据的混合方法研究。
共有 235 名 TRD 患者随机分配继续接受常规全科医生护理，在一年中每隔 3 个月进行一次随访。通过自我报告收集抗抑郁药物、全科医生就诊次数和接受的其他治疗的数据。此外，在 6 个月随访后，对一个有目的的样本进行了 14 次半结构化的面对面访谈，并进行了主题分析。
大多数患者在基线和 3 个月之间继续使用相同剂量的单一抗抑郁药（=186 人中有 147 人在 3 个月时，79%（95%置信区间[CI]为 73 至 85%））。后来的随访也相似（例如，9-12 个月：72%（95% CI 为 63 至 79%））。药物治疗改变（增加剂量；改用另一种抗抑郁药；添加第二种抗抑郁药）很少见。参与者主要描述常规治疗为服用抗抑郁药，咨询主要集中在其他（身体）健康问题上。很少有人接受其他治疗或转介到二级保健。
TRD 患者的常规治疗主要包括服用抗抑郁药，药物治疗改变并不常见。身体和心理合并症的高患病率意味着，当这些患者就诊时，他们的抑郁症可能不会被讨论。需要采取策略来确保积极管理这一大群对抗抑郁药物治疗无反应的患者。
