title: The severity of major depression and choice of treatment in primary care practice.
abstract: The Agency for Health Care Policy and Research Depression Guideline Panel recommended pharmacotherapy as the 1st-line treatment for more severely depressed primary care patients, but research supporting its recommendation has not been conducted with this population. A post hoc analysis was conducted, therefore, with data gathered in a randomized controlled trial about the relationship between initial level of depressive severity and functional ability, treatment with nortriptyline hydrochloride (NT) or interpersonal psychotherapy (IPT), and clinical course over 8 months among primary care patients experiencing major depression. Treatment type was unrelated to clinical course among more severely depressed patients (baseline 17-item Hamilton Rating Scale for Depression [HRSD] score > or = 20). However, less severely depressed patients (baseline 17-item HRSD score < or = 19) who were prescribed NT improved significantly more rapidly during the initial 3 months of treatment than patients provided with IPT.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, USA. schulbergh@msx.upmc.edu
authors.forename: H C
authors.initials: HC
authors.lastname: Schulberg
authors.forename: P A
authors.initials: PA
authors.lastname: Pilkonis
authors.forename: P
authors.initials: P
authors.lastname: Houck
mesh_terms: D000293:Adolescent; D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D017408:Guidelines as Topic / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use*; D011320:Primary Health Care / Q000592:standards*; D011614:Psychotherapy, Brief / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States; D016270:United States Agency for Healthcare Research and Quality
chemical_list: D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline