‘Watchful waiting’ or ‘active monitoring’ in depression management in primary care: Exploring the recalled content of general practitioner consultations

Abstract

BackgroundCurrent NICE depression guidelines recommend a period of ‘active monitoring’ prior to commencing treatment with antidepressants. The content of consultations during active monitoring or supportive care has not been previously prescribed. MethodsAs part of a randomised trial of supportive care versus supportive care plus SSRI consultation content was measured through patient recall for the purpose of testing equity in content between trial arms. An exploratory analysis of the consultation content measure is presented together with a measure of consultation satisfaction (MISS) and depression severity (HMRD). A score for ‘psychoactive consultation content’ (PSAC) was generated to enable comparison between groups. Results220 patients were randomised in the study. The majority of participants recalled a discussion of practical problems they faced and many reported some element of problem solving; a significant minority reported discussions about changing the way they thought, addressing relationships or talking to trusted friends or family. Consultation content was unrelated to depression outcome although in multivariate analysis it was strongly related to consultation satisfaction. LimitationsThis is a secondary analysis based on patient recall of consultation content. ConclusionsSupportive care is not a passive process as patients report several potentially therapeutic discussions within the consultation and these occur regardless of whether antidepressants are prescribed. It is not known whether these discussions do have any therapeutic value in this context. Consultation content was unrelated to outcome in this study but did predict satisfaction with the consultation. Further work is required to validate the patient report of consultation content and to identify what if any consultation strategies have therapeutic effect.