Depression In Primary Care Practice Research Articles

Effects of the Treatment of Carpal Tunnel Syndrome with Surgery and Injections on the Hospital Anxiety and Depression Scale (HADS)

Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19; p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03; p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.

No major benefit in adding mirtazapine for depression in primary care practices

Adding mirtazapine to a selective serotonin reuptake inhibitor (SSRI) or serotonin‐norepinephrine reuptake inhibitor (SNRI) for the treatment of treatment‐resistant depression did not significantly improve depressive symptoms over placebo in a trial involving 480 adults recruited from primary care practices. Adverse events were more common in the mirtazapine group and led to a high number of discontinuations from treatment, the researchers reported. Study results were published online Oct. 31 in the BMJ.

The relation between type II diabetes and chronic depression in primary care practice in Jordan

The relation between type II diabetes and chronic depression in primary care practice in Jordan

Misdiagnosis of Bipolar Depression in Primary Care Practices

Misdiagnosis of bipolar disorder is too frequent in primary care practices. Early diagnosis of the disease is crucial for appropriate treatment and optimal outcomes, yet patients may go years without a proper diagnosis. Misdiagnosis of unipolar depression may occur when patients with depressive symptomatology report no manic or hypomanic episodes. Furthermore, bipolar disease may begin as depression and develop into bipolar disorder. Primary care physicians can watch for several red flags in patients with depressive episodes, such as poor functioning in social and work arenas, risky behaviors, and legal issues. Other warning signs include a family history of bipolar disorder, psychosis at the index depressive episode, young age at onset of depression, and either antidepressant resistance or antidepressant-induced mania or hypomania. Correct and timely recognition of bipolar disorder by primary care physicians can provide long-lasting benefits for the patient.

Improvement Urged in Care of Older Depressed Patients

Ten years after an effective collaborative model for treatment was developed, help for depressed elderly patients is still inadequate.

Cultural differences in depression-related stigma in late-life: a comparison between the USA, Russia, and South Korea

Depression is a common and treatable illness in late-life. However, many do not seek treatment and may suffer from the stigma of the illness, which may vary across cultures. The aim of this study was to compare attitudes about depression in primary care practices in South Korea, Russia, and the USA. A cross-sectional study was undertaken using a self-administered questionnaire and PHQ-9 diagnostic survey with 1,094 patients aged 60-93 years who attended a primary care clinic in Korea, Russia, or the USA. The mean age of participants was 71 years, with 61% being female. US patients were older and had higher education levels. Russian participants were more likely to be widowed and had lower self-rated health. The majority of participants agreed that depression is a kind of disease (Korea 77%, Russia 61%, USA 79%). Only 6% of US patients believed depression means a person is weak, compared to 78% (Korea) and 61% (Russia). Fewer US patients endorsed depression as a normal part of aging (29% vs. Korea at 42% and Russia at 54%). Among participants in the USA, age correlated negatively with endorsement of a medical model of depression (p = <0.001). Though there was wide variation between countries in attitudes about depression, the majority of each endorsed items reflected a medical model of depression. Korean and Russian participants endorsed the view of depression as a personal weakness more than participants in the USA. Demographic correlates of negative attitudes about depression were moderate to weak.

Predictors of Treatment with Duloxetine or Venlafaxine XR among Adult Patients Treated for Depression in Primary Care Practices in the United Kingdom.

Background. Knowledge about real-world use of duloxetine and venlafaxine XR to treat depression in the UK is limited. Aims. To identify predictors of duloxetine or venlafaxine XR initiation. Method. Adult depressed patients who initiated duloxetine or venlafaxine XR between January 1, 2006 and September 30, 2007 were identified in the UK's General Practice Research Database. Demographic and clinical predictors of treatment initiation with duloxetine and venlafaxine XR were identified using logistic regression. Results. Patients initiating duloxetine (n = 909) were 4 years older than venlafaxine XR recipients (n = 1286). Older age, preexisting unexplained pain, respiratory disease, and pre-period use of anticonvulsants, opioids, and antihyperlipidemics were associated with increased odds of initiating duloxetine compared to venlafaxine XR. Pre-period anxiety disorder was associated with decreased odds of receiving duloxetine. Conclusion. Initial treatment choice with duloxetine versus venlafaxine XR was primarily driven by patient-specific mental and medical health characteristics. General practitioners in the UK favor duloxetine over venlafaxine XR when pain conditions coexist with depression.

Collaborative Care for Depressed Patients With Chronic Medical Conditions: A Randomized Trial in Puerto Rico

This study examined whether a collaborative care model for depression would improve clinical and functional outcomes for depressed patients with chronic general medical conditions in primary care practices in Puerto Rico. A total of 179 primary care patients with major depression and chronic general medical conditions were randomly assigned to receive collaborative care or usual care. The collaborative care intervention involved enhanced collaboration among physicians, mental health specialists, and care managers paired with depression-specific treatment guidelines, patient education, and follow-up. In usual care, study personnel informed the patient and provider of the diagnosis and encouraged patients to discuss treatment options with their provider. Depression severity was assessed with the Hopkins Symptom Checklist; social functioning was assessed with the 36-item Short Form. Compared with usual care, collaborative care significantly reduced depressive symptoms and improved social functioning in the six months after randomization. Integration of collaborative care in primary care practices considerably increased depressed patients' use of mental health services. Collaborative care significantly improved clinical symptoms and functional status of depressed patients with coexisting chronic general medical conditions receiving treatment for depression in primary care practices in Puerto Rico. These findings highlight the promise of the collaborative care model for strengthening the relationship between mental health and primary care services in Puerto Rico.

Collaborative Care for Depressed Patients With Chronic Medical Conditions: A Randomized Trial in Puerto Rico

Collaborative Care for Depressed Patients With Chronic Medical Conditions: A Randomized Trial in Puerto Rico

Family history of suicide: A clinical marker for major depression in primary care practice?

Background The aim of this study was to investigate the family history of suicide among primary care patients with or without current major depressive episode (MDE). Methods This study was performed in 2 GP practices in Budapest on 255 consecutively investigated primary care attendees. The diagnosis of current MDE (symptomatic MDE or MDE in partial remission) was made by the Hungarian version of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Family history of suicide was rated as positive where the patients reported at least one first or second degree relative with completed suicide. Results Out of the 255 consecutively investigated patients 45 (17.6%) have had current MDE and 24 (9.4%) have had positive family history of suicide. The family history of suicide was significantly more common among patients with current MDE than among those without it (26.6% vs 5.7%, p = 0.0001). Fifty percent of patients with, and 14.3% of patients without family history of suicide have had current MDE ( p = 0.0001). Limitation Small sample size, and lacking data on fully remitted major depressives as well as on comorbid psychiatric and medical disorders. Conclusion History of completed suicide among first or second degree relatives could be a good and simple clinical marker for current and lifetime MDE in primary care patients.

Care Management for Depression in Primary Care Practice: Findings From the RESPECT-Depression Trial

This qualitative study examined the barriers to adopting depression care management among 42 primary care clinicians in 30 practices. The RESPECT-Depression trial worked collaboratively with 5 large health care organizations (and 60 primary care practices) to implement and disseminate an evidence-based intervention. This study used semistructured interviews with 42 primary care clinicians from 30 practice sites, 18 care managers, and 7 mental health professionals to explore experience and perceptions with depression care management for patients. Subject selection in 4 waves of interviews was driven by themes emerging from ongoing data analysis. Primary care clinicians reported broad appreciation of the benefits of depression care management for their patients. Lack of reimbursement and the competing demands of primary care were often cited as barriers. These clinicians at many levels of initial enthusiasm for care management increased their enthusiasm after experiencing care management through the project. Psychiatric oversight of the care manager with suggestions for the clinicians was widely seen as important and appropriate by clinicians, care managers, and psychiatrists. Clinicians and care managers emphasized the importance of establishing effective communication among themselves, as well as maintaining a consistent and continuous relationship with the patients. The clinicians were selective in which patients they referred for care management, and there was wide variation in opinion about which patients were optimal candidates. Care managers were able to operate both from within a practice and more centrally when specific attention was given to negotiating communication strategies with a clinician. Care management for depression is an attractive option for most primary care clinicians. Lack of reimbursement remains the single greatest obstacle to more widespread adoption.

A System-Based Approach to Depression Management in Primary Care Using the Patient Health Questionnaire-9

Primary care physicians are more likely to see patients with depression than with any other disorder except hypertension, and its management poses a challenge to busy primary care practices. The Patient Health Questionnaire-9, a simple self-administered tool of proven validity and reliability, is a commonly used screening instrument for depression in primary care practice. This review article provides a system-based approach to depression management using the Patient Health Questionnaire-9 to guide clinicians in the identification and treatment of depression and its follow-up care.

Primary care physician satisfaction with patients diagnosed with depression: International Depression Project results from Colombia

To characterize physician satisfaction with doctor-patient encounters, distinguishing between those involving patients diagnosed with depression and those involving patients without depression, as well as to determine the impact of an educational intervention aimed at improving the recognition and management of depression in primary care practice, in Bogotá, Columbia. Physician satisfaction when treating outpatients in primary care centers was assesed by means of a questionnaire applied before and after the intervention. The intervention was given to 18 physicians and 5 nurses. A total of 1650 questionnaires related to visits were collected in the first phase, and 1832 were collected in the second one. The percentage of patients diagnosed with depression increased from 5.9% (95% CI: 4.8-7.1%) before the intervention to 10.6% (95% CI: 9.2-12.06%) after. The total duration of the clinical encounter did not change significantly. The percentage of time spent on the physical problems/concerns of the patients decreased in both types of visits. Health professional satisfaction was the greatest when dealing with the physical problems of the patient. However, in both types of visits, the degree of satisfaction when dealing with the psychological aspects increased after the intervention.

Improving Care for Depression: There's No Free Lunch

Primary care clinicians know depression well, yet diagnostic and treatment failures are common. In answer to the pressing need to do better, the elegant study by Dobscha and colleagues in this issu...

The effectiveness of psychotherapy in treating depressive disorders in primary care practice: clinical and cost perspectives

This paper reviews the clinical and cost effectiveness of psychotherapy for treating major and minor depression in primary care practice. Conclusions drawn from psychotherapy studies completed prior to 1995 were constrained by methodological deficiencies such as ambiguity regarding patient diagnostic status, use of non-specific psychotherapies, and lack of treatment manuals. More recent studies have addressed these flaws by shifting from efficacy to effectiveness designs, using standard diagnostic assessment procedures and appropriate follow-up time periods, using empirically evaluated treatment manuals, and selecting appropriate comparison conditions. Twelve primary care studies meeting these design criteria were analyzed, and the following conclusions were drawn: When used to treat major depression, a depression-specific psychotherapy produces better clinical outcomes than a primary care physician’s usual care and outcomes similar to those produced by pharmacotherapy. When used to treat minor depression or dysthymia, the effectiveness of psychotherapy in comparison to usual care remains more equivocal. A review of the sparse data on cost effectiveness suggests that while psychotherapy has a higher fiscal cost than a physician’s usual care, psychotherapy’s higher value in treating patients with major depression may justify its use.

Managing late-life depression in primary care practice: a case study of the Health Specialist's role.

Complexities in the diagnosis and treatment of late-life depression have stimulated various strategies for assisting the primary care physician to fulfil these tasks more effectively. The role of Health Specialist was developed for this purpose in a study to reduce suicidality among older depressed patients. This role includes clinical and case management tasks which aim to provide the physician with timely, patient-specific information and recommendations. Evolution of this role and its rewards/stressors during the study's first year are described.

Depression: Diagnosis and Management for the Primary Care Physician

BACKGROUND: Much has been learned in recent years about the diagnosis and treatment of depression, a serious, commonly overlooked psychiatric illness often seen initially by the primary care physician. The objective of this article is to review the diagnosis and treatment of depression in primary care practice. METHOD: Relevant articles on depression were identified by a comprehensive MEDLINE search and classified into the following categories: diagnosis and screening, nonpharmacologic therapy, pharmacologic therapy, newer antidepressant agents, and maximizing antidepressant therapy. The importance to primary care practice was considered in determining the significance of each article reviewed. RESULTS: Because no laboratory tests exist for depression and no biological markers can be measured routinely, the diagnosis of depression must be made with a number of reliable depression scales and questionnaires that can be completed quickly in the primary care setting. The considerable overlap between depressive and anxiety disorders further complicates an accurate diagnosis. Remission (i.e., absence of symptoms) is the ultimate goal of therapy for patients who have depressive symptoms. CONCLUSION: Many patients can be treated safely and effectively for depression in the primary care setting with pharmacologic therapy, which, if completely successful, can lead to full remission of the disorder.

Who Gets Prescriptions for Antidepressants

Several studies have demonstrated the underrecognition and undertreatment of clinical depression in primary care practice. Does specialty mental health

Standardised nortriptyline and psychotherapy were more effective and more expensive than usual care in major depression

Lave JR, Frank RG, Schulberg HC , et al. Cost-effectiveness of treatments for major depression in primary care practice. Arch Gen Psychiatry1998 Jul; 55 : 645 –51 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4]...

Symptom Attribution and Physicians' Detection of Depression

The low rate (about 50%) of detection of depression in primary care practice has been ascribed both to doctors' problematic skills and attitudes and to depressed patients' tendency to present with physical complaints (somatization). This study of 305 consecutive British primary care …