Effects of medical illness and somatic symptoms on treatment of depression in a family medicine residency practice

Abstract

The specific aims of this pilot study were to describe the treatment received by depressed patients in a family practice residency setting and to compare treatment modalities and intensity of treatment between patients with and without medical illnesses. A 12-month chart audit of a cohort of 340 patients randomly sampled from a family practice waiting room for a previous study revealed a 1-year period prevalence for diagnosed depression of 10.3% (35 patients). No patient met DSM-III-R criteria for major depressive disorder and yet 57% received tricyclic antidepressant therapy and 60% were eventually referred for specialist mental health care. Tricyclic therapy and follow-up visits for depression were less likely to take place for patients with more severe medical illnesses or high levels of somatic symptoms. These findings suggest that patients in primary care settings may have depressive symptoms severe enough to provoke tricyclic therapy or referral but do not meet current diagnostic criteria. Furthermore, medical illness and somatic symptoms may deleteriously affect treatment in primary care patients. Additional prospective research is needed to determine appropriate criteria for treatment of depressive symptoms in primary care patients and to evaluate the effects of medical illness and somatic symptoms on treatment by primary care physicians.