title: Maintenance pharmacotherapy for recurrent major depressive disorder in primary care: A 5-year follow-up study.
abstract: Most practice guidelines recommend maintenance antidepressant treatment for recurrent major depressive disorder. However, the degree to which such guidance is actually followed in primary health care has remained obscure. We investigated the provision of maintenance antidepressant treatment within a representative primary care five-year cohort study.
  
  
  
  In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II interviews. Of the 137 patients with depressive disorders, 82% completed the prospective five-year follow-up. A graphic life chart enabling evaluation of the longitudinal course of episodes plus duration of pharmacotherapies was used. In accordance with national guidelines, an indication for maintenance treatment was defined to exist after three or more lifetime major depressive episodes (MDEs); maintenance treatment was to commence four months after onset of full remission.
  
  
  
  Of the cohort patients, 34% (46/137) had three or more lifetime MDEs, thus indicating the requirement for maintenance pharmacotherapy. Of these, half (54%, 25/46) received maintenance treatment, for only 29% (489/1670) of the months indicated.
  
  
  
  In this cohort of depressed primary care patients, half of patients with indications for maintenance treatment actually received it, and only for a fraction of the time indicated. Antidepressant maintenance treatment for the prevention of recurrences is unlikely to be subject to large-scale actualization as recommended, which may significantly undermine the potential public health benefits of treatment.
authors.affiliation: Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Health Care and Social Services, City of Järvenpää, Järvenpää, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Riihimäki
authors.affiliation: Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Vuorilehto
authors.affiliation: Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki, Helsinki University Hospital, Helsinki, Finland. Electronic address: erkki.isometsa@hus.fi.
authors.forename: E
authors.initials: E
authors.lastname: Isometsä
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D055502:Secondary Prevention / Q000706:statistics & numerical data*
chemical_list: D000928:Antidepressive Agents
keywords: Depression; Maintenance pharmacotherapy; Primary care