Treating major depression in primary care practice: an update of the Agency for Health Care Policy and Research Practice Guidelines.
The Depression Guideline Panel of the Agency for Health Care Policy and Research in 1993 published recommendations for treating major depression in primary care practice that were often based on studies of tertiary care psychiatric patients. We reviewed reports of randomized controlled trials in primary care settings published between 1992 and 1998. This evidence indicates that both antidepressant pharmacotherapy and time-limited depression-targeted psychotherapies are efficacious when transferred from psychiatric to primary care settings. In most cases, the choice between these treatments should depend on patient preference. Studies to date suggest that improving treatment of depression in primary care requires properly organized treatment programs, regular patient follow-up, monitoring of treatment adherence, and a prominent role for the mental health specialist as educator, consultant, and clinician for the more severely ill. Future research should focus on how guidelines are best implemented in routine practice, since conventional dissemination strategies have little impact.
Schulberg
H C
HC
Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA. schulbergh@msx.upmc.edu
Katon
W
W
Simon
G E
GE
Rush
A J
AJ
D000928:Antidepressive Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011570:Psychiatry; D011613:Psychotherapy; D012017:Referral and Consultation; D016896:Treatment Outcome; D014481:United States; D016270:United States Agency for Healthcare Research and Quality
D000928:Antidepressive Agents