Depression in primary care: interpersonal counseling vs selective serotonin reuptake inhibitors. The DEPICS Study. A multicenter randomized controlled trial. Rationale and design.
BACKGROUND
Depression is a frequently observed and disabling condition in primary care, mainly treated by Primary Care Physicians with antidepressant drugs. Psychological interventions are recommended as first-line treatment by the most authoritative international guidelines but few evidences are available on their efficacy and effectiveness for mild depression.


METHODS
This multi-center randomized controlled trial was conducted in 9 Italian centres with the aim to compare the efficacy of Inter-Personal Counseling, a brief structured psychological intervention, to that of Selective Serotonin Reuptake Inhibitors. Patients with depressive symptoms referred by Primary Care Physicians to psychiatric consultation-liaison services were eligible for the study if they met the DSM-IV criteria for major depression, had a score ≥ 13 on the 21-item Hamilton Depression Rating Scale, and were at their first or second depressive episode. The primary outcome was remission of depressive symptoms at 2-months, defined as a HDRS score ≤ 7. Secondary outcome measures were improvement in global functioning and recurrence of depressive symptoms at 12-months. Patients who did not respond to Inter-Personal Counseling or Selective Serotonin Reuptake Inhibitors at 2-months received augmentation with the other treatment.


CONCLUSIONS
This trial addresses some of the shortcomings of existing trials targeting major depression in primary care by evaluating the comparative efficacy of a brief psychological intervention that could be easily disseminated, by including a sample of patients with mild/moderate depression and by using different outcome measures.


BACKGROUND
Australian New Zealand Clinical Trials Registry ACTRN12608000479303.
Institute of Psychiatry, Bologna University, Bologna, Italy. marco.menchetti3@unibo.it
Marco
M
Menchetti
Biancamaria
B
Bortolotti
Paola
P
Rucci
Paolo
P
Scocco
Annarosa
A
Bombi
Domenico
D
Berardi
D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D003131:Combined Modality Therapy; D003376:Counseling / Q000379:methods*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D017063:Outcome Assessment, Health Care; D010549:Personal Satisfaction; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief; D012107:Research Design; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D017367:Selective Serotonin Reuptake Inhibitors