The course of depressive illness in general practice.
OBJECTIVE
Depression is reported to be common in primary care settings and to have a high likelihood of relapse during the 4- to 6-month period following initial symptomatic improvement. However, most prospective studies of long-term treatment of depression have been conducted with patients selected for participation in placebo-controlled drug protocols or psychiatric clinics associated with tertiary referral centres.


METHODS
We examined the treatment course and outcome of outpatients with major depressive episode treated in a primary care setting. The general practitioners were free to choose the treatment and its duration. Their only obligation was to assess the therapeutic outcome in terms of efficacy and safety and to perform a final evaluation at the end of the 6-month observation period or, if the patient was treated for a shorter period, at the end of the treatment.


RESULTS
Of the 476 patients involved, 308 (64.7%) responded to treatment and remained well, 117 (24.6%) showed no response, and 51 (10.7%) had an early relapse after initial improvement. Among the studied demographic, clinical, and therapeutic factors, the history of recurrent depression was the only variable with a significant effect size in predicting the course of the illness.


CONCLUSIONS
Patients with recurrent depression were at higher risk of relapse or nonresponse.
Limosin
Frédéric
F
Department of Psychiatry, Albert Chenevier Hospital, Créteil, France. frederic.limosin@wanadoo.fr
Loze
Jean-Yves
JY
Zylberman-Bouhassira
Myriam
M
Schmidt
Mark E
ME
Perrin
Eléna
E
Rouillon
Frédéric
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D012008:Recurrence; D012306:Risk; D016896:Treatment Outcome
D000928:Antidepressive Agents