title: Continuity is the main challenge in treating major depressive disorder in psychiatric care.
abstract: OBJECTIVE
  Several evidence-based treatment guidelines for major depressive disorder (MDD) have been published. However, little is known about how recommendations for treatment are adhered to by patients in current usual psychiatric practice.
  
  
  METHODS
  The Vantaa Depression Study is a prospective, naturalistic cohort study of 269 psychiatric patients with a new episode of DSM-IV MDD who were interviewed with the Schedules for Clinical Assessment in Neuropsychiatry and Structured Clinical Interview for DSM-III-R Personality Disorders between February 1, 1997, and May 31, 1998, and again at 6 and 18 months. Treatments provided, as well as adherence to and attitudes toward both antidepressants and psychotherapeutic support/psychotherapy, were investigated among the 198 unipolar patients followed for 18 months.
  
  
  RESULTS
  Most depression patients (88%) received antidepressants in the early acute phase, but about half (49%) terminated treatment prematurely. This premature termination was associated with worse outcome of major depressive episodes, and with negative attitudes, mainly explained by fear of dependence on or side effects of antidepressants. Nearly all patients (98%) received some psychosocial treatment in the acute phase; about one fifth (16%) had weekly psychotherapy during the follow-up. About a quarter of patients admitted nonadherence to ongoing treatments.
  
  
  CONCLUSIONS
  Problems of psychiatric care seem most related to continuity of treatment. While adequate treatments are provided in the early acute phase, antidepressants are terminated too soon in about half of patients, often following their autonomous decisions. From a secondary and tertiary preventive point of view, improving continuity of treatment would appear a crucial task for improving the outcome of psychiatric patients with MDD.
authors.affiliation: Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
authors.forename: Tarja K
authors.initials: TK
authors.lastname: Melartin
authors.forename: Heikki J
authors.initials: HJ
authors.lastname: Rytsälä
authors.forename: Ulla S
authors.initials: US
authors.lastname: Leskelä
authors.forename: Paula S
authors.initials: PS
authors.lastname: Lestelä-Mielonen
authors.forename: T Petteri
authors.initials: TP
authors.lastname: Sokero
authors.forename: Erkki T
authors.initials: ET
authors.lastname: Isometsä
mesh_terms: D000208:Acute Disease; D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001294:Attitude to Health; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000592:standards*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D004334:Drug Administration Schedule; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010352:Patient Dropouts; D011314:Preventive Health Services / Q000592:standards; D011336:Probability; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents