title: Adequate initial antidepressant treatment among patients with chronic obstructive pulmonary disease in a cohort of depressed veterans.
abstract: OBJECTIVE
  Depression is common among patients with chronic obstructive pulmonary disease (COPD). Patients with COPD may be more likely to have inadequate treatment with antidepressant medications. We tested the hypothesis that depressed patients with COPD have lower odds of adequate duration of antidepressant therapy in the first 3 months of treatment compared to those without COPD.
  
  
  METHODS
  Using administrative and centralized pharmacy data from 14 northeastern Veterans Affairs Medical Centers, we identified 778 veterans with depression (ICD-9-CM codes 296.2x, 296.3x, and 311.xx) who were in the acute phase of antidepressant treatment from June 1, 1999, through August 31, 1999. Within this group, we identified those patients with COPD (23%). An adequate duration of antidepressant treatment was defined as ≥ 80% of days on an antidepressant. We used multivariable logistic regression models to determine the adjusted odds of adequate acute phase antidepressant treatment duration.
  
  
  RESULTS
  Those patients with COPD had markedly lower odds of adequate acute phase treatment duration (odds ratio = 0.67, 95% CI = 0.47 to 0.96); this was not observed with other medical diagnoses such as coronary heart disease, diabetes mellitus, or osteoarthritis.
  
  
  CONCLUSIONS
  The first few months of treatment appears to be a critical period for depressed patients with COPD who are started on antidepressants. The causes for early antidepressant treatment inadequacy among patients with COPD require further investigation. More intensive efforts may be necessary early in the course of treatment to assure high-quality pharmacologic therapy of depressed patients with COPD.
authors.affiliation: Division of Biology and Medicine, Brown University, Providence, R.I., USA. Paul_Pirraglia@brown.edu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pirraglia
authors.forename: Andrea
authors.initials: A
authors.lastname: Charbonneau
authors.forename: Boris
authors.initials: B
authors.lastname: Kader
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz