Applicability of clinical pharmacotherapy guidelines for major depression in primary care settings.

OBJECTIVE

To determine whether guidelines established for pharmacologic treatment of major depression are feasible in primary care.

DESIGN

Prospective cohort study.

SETTING

Ambulatory family health centers and internal medicine clinics.

PATIENTS

Ninety-one primary care patients meeting criteria within the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition for a current major depression randomized to receive antidepressant medication after being judged by a psychiatrist as clinically eligible for pharmacotherapy in an ambulatory setting.

INTERVENTION

Nortriptyline hydrochloride prescribed by primary care physicians trained in clinical guidelines specifying dosage schedules, durations, and procedures resembling those recommended by the AHCPR (Agency for Health Care Policy and Research) Depression Guideline Panel.

MAIN OUTCOME MEASURES

Patient participation and continuation in medication treatment.

RESULTS

Fifty-five percent of patients completed the acute phase of treatment after a mean of 6.9 visits extending over a mean of 8.1 weeks. Of those patients entering the continuation phase, 60% completed the follow-up visits for 6 months. Taken together, only 33% of patients assigned to receive antidepressant medication completed the full regimen recommended by the AHCPR guidelines.

CONCLUSIONS

The treatment of depressed primary care patients within AHCPR guidelines for antidepressant medication is feasible but complex. Although primary care physicians ably adhere to these guidelines, keeping patients in treatment is difficult and possibly requires greater flexibility in treatment regimens.