Assessing effectiveness of treatment of depression in primary care

Abstract

Background and Objectives: Patients who present to general practitioners with depression often receive antidepressant medication when they would prefer to receive counseling. The authors attempted to determine whether patients who agree to random assignment to treatment differ from those who choose their treatment, whether medication or counseling is more effective in treating depression in primary care patients, and whether patients' response to and satisfaction with treatment are influenced by their being allowed to choose the type of treatment they receive. Method: Patients were recruited from primary care practices across the Trent region of Great Britain. In a partially randomized preference trial, patients meeting Research Diagnostic Criteria for major depression were first asked if they would agree to be randomly assigned to either medication treatment or counseling; participants who refused random assignment were allowed to choose which treatment they would receive. No treatment differences existed between patients randomly assigned and those who chose their treatment type. Results: A total of 103 patients (52 allocated to counseling and 51 to antidepressant medication) agreed to random assignment to treatment and 220 (140 who chose counseling and 80 who chose medication) selected their preferred treatment. No baseline differences existed between randomly assigned patients and those who chose their treatment In addition, no differences in efficacy were found after 8 weeks of treatment either between the 2 types of treatment or within treatment groups when randomly assigned patients and those who selected their treatment were compared. Overall, treatment outcome was not affected by the ability to select a preferred mode of treatment. Conclusions: Although the findings need to be replicated to increase their generalizability, they suggest that current assumptions about treatment of depression in primary care should be reexamined.