Abstract
BackgroundNon-response to antidepressant medication is common in primary care. Little is known about how GPs manage patients with depression that does not respond to medication.AimTo describe usual care for primary care patients with treatment-resistant depression (TRD).Design and settingMixed-methods study using data from a UK primary care multicentre randomised controlled trial.MethodIn total, 235 patients with TRD randomised to continue with usual GP care were followed up at 3-month intervals for a year. Self-report data were collected on antidepressant medication, number of GP visits, and other treatments received. In addition, 14 semi-structured face-to-face interviews were conducted with a purposive sample after the 6-month follow-up and analysed thematically.ResultsMost patients continued on the same dose of a single antidepressant between baseline and 3 months (n = 147/186 at 3 months, 79% (95% confidence interval [CI] = 73 to 85%)). Figures were similar for later follow-ups (for example, 9–12 months: 72% (95% CI = 63 to 79%). Medication changes (increasing dose; switching to a different antidepressant; adding a second antidepressant) were uncommon. Participants described usual care mainly as taking antidepressants, with consultations focused on other (physical) health concerns. Few accessed other treatments or were referred to secondary care.ConclusionUsual care in patients with TRD mainly entailed taking antidepressants, and medication changes were uncommon. The high prevalence of physical and psychological comorbidity means that, when these patients consult, their depression may not be discussed. Strategies are needed to ensure the active management of this large group of patients whose depression does not respond to antidepressant medication.
Highlights
Antidepressants are usually the first line of treatment for those with moderate or severe depression in primary care.[1]
Participants described usual care mainly as taking antidepressants, with consultations focused on other health concerns
Strategies are needed to ensure the active management of this large group of patients whose depression does not respond to antidepressant medication
Summary
Antidepressants are usually the first line of treatment for those with moderate or severe depression in primary care.[1] In 2014, 57.1 million prescriptions for antidepressants were dispensed, more than double the number issued 10 years earlier (28.2 million in 2004).[2] There is evidence to suggest that the increase in prescribing seen in recent years is largely the result of more patients receiving longterm treatment.[3,4,5] In one fairly recent study, 47% of patients had been taking the same antidepressant for more than 2 years.[6]. Non-response to antidepressant medication is common in primary care. Little is known about how GPs manage patients with depression that does not respond to medication
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