Outcome Of Major Depression Research Articles

Neural correlates of treatment outcome in major depression

There is a need to identify clinically useful biomarkers in major depressive disorder (MDD). In this context the functional connectivity of the orbitofrontal cortex (OFC) to other areas of the affect regulation circuit is of interest. The aim of this study was to identify neural changes during antidepressant treatment and correlates associated with the treatment outcome. In an exploratory analysis it was investigated whether functional connectivity measures moderated a response to mirtazapine and venlafaxine. Twenty-three drug-free patients with MDD were recruited from the Department of Psychiatry and Psychotherapy of the Ludwig-Maximilians University in Munich. The patients were subjected to a 4-wk randomized clinical trial with two common antidepressants, venlafaxine or mirtazapine. Functional connectivity of the OFC, derived from functional magnetic resonance imaging with an emotional face-matching task, was measured before and after the trial. Higher OFC connectivity with the left motor areas and the OFC regions prior to the trial characterized responders (p<0.05, false discovery rate). The treatment non-responders were characterized by higher OFC-cerebellum connectivity. The strength of response was positively correlated with functional coupling between left OFC and the caudate nuclei and thalami. Differences in longitudinal changes were detected between venlafaxine and mirtazapine treatment in the motor areas, cerebellum, cingulate gyrus and angular gyrus. These results indicate that OFC functional connectivity might be useful as a marker for therapy response to mirtazapine and venlafaxine and to reconstruct the differences in their mechanism of action.

Impact of prior pharmacotherapy on remission of psychotic depression in a randomized controlled trial

Having failed to respond to an adequate antidepressant treatment course predicts poorer treatment outcomes in patients with major depression. However, little is known about the impact of prior treatment on the outcome of major depression with psychotic features (MDpsy). We examined the effect of prior treatment history on the outcome of pharmacotherapy of MDpsy in patients who participated in the STOPD-PD study, a randomized, double-blind, clinical trial comparing a combination of olanzapine plus sertraline vs. olanzapine plus placebo. The strength of treatment courses received prior to randomization was classified using a validated method. A hierarchy of outcomes was hypothesized based on treatments received prior to randomization and randomized treatment. A high remission rate was observed in subjects with a history of no prior treatment or inadequate treatment who were treated with a combination of olanzapine and sertraline. A low remission rate was observed in subjects who had previously failed to respond to an antidepressant alone and who were treated with olanzapine monotherapy. A low remission rate was also observed in subjects who had previously failed to respond to a combination of an antipsychotic and an antidepressant. Similar to patients with major depression, these results emphasize the impact of prior pharmacotherapy on treatment outcomes in patients with MDpsy.

Remission in major depression: results from a geriatric primary care population

While a recent task force report recommended that remission from major depression be defined according to DSM criteria, most previous work has used depressive symptom rating scales. The current study sought to identify baseline factors associated with treatment outcome in major depression, diagnosed according to DSM-IV criteria. Data from the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study were utilized. This analysis focused on 792 geriatric primary care patients with major depression at baseline, which was randomized to services by a mental health professional in primary care or specialty settings. Major depression was diagnosed according to DSM-IV criteria based on a structured interview at baseline and 6 months. The primary outcome was the absence of any DSM-IV depressive disorder at six-month follow-up. Association with baseline demographic characteristics, comorbid anxiety disorder, 'at risk' drinking, number of co-occurring medical conditions, and depressive symptom severity was examined using multiple logistic regression modeling. Remission occurred in 228 (29%) patients with completed follow-up assessments, while 564 (71%) did not remit. Factors which increased the odds of non-remission included comorbid anxiety (OR=1.60, 95% CI 1.11-2.31), female sex (OR=1.49, 95% CI 1.04-2.15), general medical comorbidity (OR=1.15, 95% CI 1.07-1.24), and increased baseline depressive symptom severity (OR=1.04, 95% CI 1.03-1.06). The findings underscore the importance of using DSM criteria to define remission from major depression, and suggest that concurrent measurement of depression severity, comorbid anxiety, and medical comorbidity are important in identifying patients requiring targeted interventions to optimize remission from major depression.

Regret and the negative evaluation of decision outcomes in major depression

Disruption of normal emotional experience is central to the phenomenology of depression. Twenty-three depressed outpatients and 23 control subjects performed a computerized decision-making task, during which affective ratings were assessed online to identify various dimensions of emotional experience. We sought to contrast regret (the comparison of the outcomes of selected and nonselected options) with the general negative appraisal of task events. The experience of regret was reduced in depressed patients, an effect that was particularly related to self-reported apathy scores. In an exploratory analysis, we observed that females had a general downward shift in their ratings, as compared with males, but disappointment and regret effects were of similar magnitude. The possible contribution of the orbitofrontal cortex to the phenomenology of regret is discussed. Supplemental materials for this article may be downloaded from http://cabn.psychonomic-journals.org/content/supplemental.

The D-allele of ACE insertion/deletion polymorphism is associated with regional white matter volume changes and cognitive impairment in remitted geriatric depression

Prior studies suggested that angiotensin-converting enzyme (ACE) affected vascular homeostasis and degradation of amyloid β (Aβ). It is associated with the therapeutic outcome in major depression. The aim of this study was to investigate the association between angiotensin-converting enzyme ( ACE) insertion/deletion (I/D) polymorphism and structural abnormalities in remitted geriatric depression (RGD), and test the relationship of neuropsychological performances and regional white matter volumes. 31 RGD patients were recruited and neuropsychological tests, magnetic resonance imaging (MRI) and genotype of ACE I/D were examined for each subject. The differences in regional white matter volume were tested between I homozygotes and D-allele carriers (I/D or D/D genotype) by optimized VBM. D-allele carriers exhibited significantly smaller white matter volumes of right superior frontal gyrus (SFG) and right anterior cingulated gyrus (ACG), but had larger volumes of left middle temporal gyrus (MTG) and right middle occipital gyrus (MOG) than I homozygotes ( P < 0.001). Meanwhile, there was a significant positive correlation between white matter volume enlargement of left MTG and Symbol Digit Modalities Test (SDMT) ( r = 0.456, P = 0.043), and the reduction of right ACG was negatively related to Clock Drawing Test (CDT) performance ( r = −0.445, P = 0.050) in D-allele carriers. The finding suggests that ACE can modulates the pathology of RGD, the left MTG and right ACG might be involved in the pathophysiology of cognitive dysfunction in RGD patients.

The Combined Dexamethasone/CRH Test (DEX/CRH Test) and Prediction of Acute Treatment Response in Major Depression

BackgroundIn this study the predictive value of the combined dexamethasone/CRH test (DEX/CRH test) for acute antidepressant response was investigated.Methodology/Principal FindingsIn 114 depressed inpatients suffering from unipolar or bipolar depression (sample 1) the DEX/CRH test was performed at admission and shortly before discharge. During their stay in the hospital patients received different antidepressant treatment regimens. At admission, the rate of nonsuppression (basal cortisol levels >75.3 nmol/l) was 24.6% and was not related to the later therapeutic response. Moreover, 45 out of 114 (39.5%) patients showed an enhancement of HPA axis function at discharge in spite of clinical improvement. In a second sample, 40 depressed patients were treated either with reboxetine or mirtazapine for 5 weeks. The DEX/CRH test was performed before, after 1 week, and after 5 weeks of pharmacotherapy. Attenuation of HPA axis activity after 1 week was associated with a more pronounced alleviation of depressive symptoms after 5-week mirtazapine treatment, whereas downregulation of HPA system activity after 5 weeks was related to clinical response to reboxetine. However, early improvement of HPA axis dysregulation was not necessarily followed by a beneficial treatment outcome.Conclusions/SignificanceTaken together, performance of a single DEX/CRH test does not predict the therapeutic response. The best predictor for response seems to be an early attenuation of HPA axis activity within 1 or 2 weeks. However, early improvement of HPA system dysfunction is not a sufficient condition for a favourable response. Since a substantial part of depressive patients display a persistence of HPA axis hyperactivity at discharge, downregulation of HPA system function is not a necessary condition for acute clinical improvement either. Our data underline the importance of HPA axis dysregulation for treatment outcome in major depression, although restoration of HPA system dysfunction seems to be neither a necessary nor a sufficient determinant for acute treatment response.

Improving long-term outcome of major depression in primary care: the role of recurrence prevention

Introduction: Major depression is a highly prevalent and often recurrent disorder. Since most depressed patients in The Netherlands are treated by general practioners, it is clear that more effective treatments in this primary care setting are needed. The main aim of the research presented in this thesis was to evaluate the effects of enhanced care for depression with a continuation-phase compared with usual care on the course and outcome of depression over three years.

Definitions of recovery and outcomes of major depression: results from a 10‐year follow‐up

Furukawa TA, Fujita A, Harai H, Yoshimura R, Kitamura T, Takahashi K. Definitions of recovery and outcomes of major depression: results from a 10-year follow-up.ObjectiveConsensus operational definitions for symptomatic remission and recovery of a major depressive episode have been proposed but only irregularly followed.MethodWe examined the predictive validity of different definitions of recovery in a multi-center 10-year follow-up study of an inception cohort of untreated unipolar major depressive episodes (n = 95). Time to recovery and time to recurrence after recovery were estimated by Kaplan–Meier survival analyses for alternative definitions requiring 2, 4, 6 or 12 months of remission to declare recovery.ResultsThe median time to recovery was 3.0, 4.0, 4.0 and 12.0 months respectively. The index episode lasted longer than 24 months in 9.4%, 9.2%, 12.6% and 24.5%. The median time to subthreshold recurrence was 16.0, 32.0, 42.0 and 74.0 months.ConclusionEither 4- or 6-month duration of remission defined a change point before which the episode was continuous and after which the recurrence was reasonably unlikely.Significant outcomes Requiring two months of remission is probably too short to declare recovery because a subthreshold recurrence occurs in more than half of the cohort within a year and a half.If we require 4 or 6 months before we declare recovery, the median time to recovery is 4 months and that to subthreshold recurrence is nearly 3 years.Requiring 12 months of remission before declaring recovery would make the episode discontinuous yet long and inflate the rate of chronicity.Limitations The sample size was relatively small and the confidence intervals were accordingly wide.This was a naturalistic study and the treatments were not controlled.Validity of alternative definitions of remission requires a separate study.

Sleep in Major Depression: Relation to Memory Performance and Outcome after Interpersonal Psychotherapy

Background: Earlier findings suggest both a link between sleep and memory consolidation and a relationship between abnormal sleep at baseline and poor treatment outcome in major depression after interpersonal psychotherapy (IPT). Methods: Pre-treatment polysomnography was examined in 32 patients with a major depressive episode (mean age = 39.5 years, 20 women). Declarative memory was tested by the Rey-Osterrieth Complex Figure Test and a paired associative word list and procedural learning was assessed by a mirror tracing skill. All patients were treated with IPT according to the manual and did not receive any antidepressant medication. Twenty-three patients took part in a minimum of 12 sessions of IPT. Remission was defined as 2 consecutive weeks with a score <8 on the Hamilton Rating Scale of Depression. Results: Declarative visual memory performance was associated with total sleep time and total amount of rapid eye movement sleep. In IPT remitters (n = 14), there was a trend towards a decrease in rapid eye movement density (first period) and a significant decrease in delta power in pre-treatment sleep in comparison to non-remitters (n = 9). Treatment outcome after IPT was also associated with declarative memory performance at baseline (as a trend). Conclusions: Further indications of a role of sleep in memory processes and of the importance of specific sleep parameters as markers for a positive treatment response to psychotherapy were found.

Attachment as moderator of treatment outcome in major depression: A randomized control trial of interpersonal psychotherapy versus cognitive behavior therapy.

Anxiety and avoidance dimensions of adult attachment insecurity were tested as moderators of treatment outcome for interpersonal psychotherapy (IPT) and cognitive- behavioral therapy (CBT). Fifty-six participants with major depression were randomly assigned to these treatment conditions. Beck Depression Inventory--II, Six-Item Hamilton Rating Scale for Depression scores, and remission status served as outcome measures. Patients higher on attachment avoidance showed significantly greater reduction in depression severity and greater likelihood of symptom remission with CBT as compared with IPT, even after controlling for obsessive-compulsive and avoidant personality disorder symptoms. Results were replicated across treatment completers and intent-to-treat samples. These results suggest that it is important to consider the interaction between attachment insecurity and treatment type when comparing efficacy of treatments.

Selective serotonin reuptake inhibitors in depression: the influence of 5-HTTLPR and STin2 on treatment effect

Genetic variation in the serotonin transporter gene hasbeen proposed as a possible explanation for inter-individ-ual differences in treatment effects of selective serotoninreuptake inhibitors (SSRIs) in major depression [1-3].Assessment of these genetic influences is necessary inorder to decide whether genetic testing in psychiatric prac-tice prior to antidepressant prescription could be useful[3]. This study evaluates the influence of two polymor-phisms in the serotonin transporter gene (5-HTTLPR andSTin2) on SSRI treatment outcome in major depression.

The impact of residual symptoms on outcome of major depression

Unipolar depression should be viewed as a chronic illness with multiple phases rather than as a relapsing-remitting disorder. Incomplete remission from depression is common, with approximately one third of patients continuing to have residual depression at remission. Patients who have had a depressive episode spend more time with residual depressive symptoms than with major depression long term. The presence of residual symptomatology after an episode of depression is associated with an increased risk of short-term relapse, a long-term chronic course, higher risk of suicide attempts, poor social functioning, and poor outcome of comorbid medical illnesses.

Psychosocial and Clinical Predictors of Symptom Persistence vs Remission in Major Depressive Disorder

The present study evaluates the impact of a range of psychosocial factors on the outcome of major depression while controlling for the effect of clinical variables. Patients (n = 171) seen in consultation at a mood disorders clinic completed measures of neuroticism, rumination, coping style, sexual abuse history, and parental bonding experiences at Time 1 and completed measures of interpersonal and achievement life events and depression 12 months later. In univariate analyses, neuroticism, rumination, interpersonal and achievement life events, and sexual abuse history were associated with nonremission, whereas avoidance coping was associated with remission at Time 2. Interpersonal and achievement life events and sexual abuse history were associated with nonimprovement, whereas avoidance coping was associated with improvement at Time 2. Significant predictors of both remission and improvement in logistic regression analyses controlling for clinical variables (depression and anxiety severity, duration of illness, and age) included avoidance, interpersonal life events, and the interaction between avoidance and interpersonal life events. Interpersonal events and responses to depression (that is, coping) play an important role in the outcome of major depression. Further attention to coping style and interactions between psychological factors and life events is warranted in future research on depression persistence.

The role of medical comorbidity in outcome of major depression in primary care: the PROSPECT study.

The authors described the influence of specific medical conditions on clinical remission and response of major depression (MDD) in a clinical trial evaluating a care-management intervention among older primary-care patients. Adults age 60 years and older were randomly selected and screened for depression. Participants were randomly assigned to Usual Care or to an Intervention with a depression care-manager offering algorithm-based care for MDD. In all, 324 adults meeting criteria for MDD were included in these analyses. Remission and response was defined by a score on the Hamilton Rating Scale for Depression <10 and by a decrease from baseline of > or =50%, respectively. Medical comorbidity was ascertained through self-report. Cognitive impairment was defined by a score <24 on the Mini-Mental State Exam (MMSE). In Usual Care, rates of remission were faster in persons who reported atrial fibrillation (AF) than in persons who did not report AF and slower in persons who reported chronic pulmonary disease than in persons who did not report chronic pulmonary disease; rates of response were less stable in persons with MMSE <24 than in those with MMSE > or =24. In the Intervention condition, none of the specific chronic medical conditions were significantly associated with outcomes for MDD. Because disease-specific findings were observed in persons who received Usual Care but not in persons who received more intensive treatment in the Intervention condition, our results suggest that the association of medical comorbidity and treatment outcomes for MDD may be determined by the intensity of treatment for depression.

The Role of Medical Comorbidity in Outcome of Major Depression in Primary Care: The PROSPECT Study

The Role of Medical Comorbidity in Outcome of Major Depression in Primary Care: The PROSPECT Study

STin2 Variant and Family History of Suicide as Significant Predictors of Suicide Completion in Major Depression

Suicide is the most serious outcome of major depression, yet not all depressed patients will commit suicide. Genes, along with other factors, might account for this difference. Serotonergic alterations have been observed in suicide and depression and impulsive-aggressive behaviors. Therefore, we aimed to identify predictors of suicide, considering genetic variation at the serotonin transporter (5-HTT) gene. We investigated the 5-HTT gene-linked polymorphic region (5-HTTLPR) and intron 2 (STin2) variants of this gene and their relationship to behavioral and clinical risk factors for suicide in a sample of depressed suicides (n =106) and depressed control subjects (n =152), diagnosed by means of proxy-based interviews. We found a significant association of suicide completion with having at least one copy of the STin2 10 allele [chi(2)(1) = 10.833, p = .002]. No differences were found for the 5-HTTLPR variable number of tandem repeats. After controlling for behavioral and clinical risk factors for suicide, the STin2 variant remained a significant predictor of suicide in major depression when jointly considered with a family history of suicide (odds ratio 5.560, 95% confidence interval 1.057-29.247). The STin2 locus might account, at least in part, for the observed familial aggregation of suicidal behavior. These results should be further explored in families where clustering of suicidal behavior is observed.

Basal Prolactin Values Correlate with Response to Reboxetine Treatment in Major Depression, but Not with Response to Citalopram

Little is known about variables that might predict outcome in major depression. Recently, basal prolactin values (BPV) have been suggested to predict response to treatment with tricyclic antidepressive drugs. In order to examine whether BPV predict response to selective mono-aminergic therapy, 24 in-patients with major depression were treated in a single-masked, randomised study using the most selective noradrenergic or serotonergic reuptake inhibitors available for antidepressant treatment, i.e. reboxetine and citalopram. A significant correlation between BPV and treatment response to reboxetine was found, but not between BPV and response to citalopram. As BPV are influenced by noradrenergic activity, it can be hypothesized that depressed patients with comparatively high BPV have a relatively high noradrenergic function. This might explain why in our study depressed patients with the highest BPV responded strongest to selective noradrenergic treatment with reboxetine. As measurement of BPV is simple, further studies are suggested to examine the possible clinical value of the link between prolactin, noradrenergic function in major depression and treatment response.

Beliefs about Depression in Patients and Their Partners

We examined beliefs about depression in patients and their partners and explored the impact of beliefs on perceptions of marital functioning, level of distress and caregiving in partners, and clinical outcome of major depression. Fifteen patients meeting criteria for major depressive disorder and their co-habiting spouses were interviewed at baseline using the Reasons for Depression Questionnaire (Addis, Truax and Jacobson, 1995) and measures of symptom severity, distress, caregiver consequences and marital satisfaction. Outcome was assessed at 6 months. Identifying biological reasons for depression was significantly associated with patient severity of depression and with caregiver burden. Caregiver distress was significantly associated with endorsement of interpersonal reasons for depression. Concordance in reason giving between patients and partners was significantly associated with a good outcome. This is the first study to show that beliefs about depression held by patients and their partners may have an impact on the clinical outcome of major depression.

Clinical and psychosocial factors associated with the outcome of unipolar major depression: a one year prospective study

Background: The role of psychosocial and clinical variables in the prediction of major depression is controversial. In a previous paper, we obtained a one-year predictive multivariate model of non-remission for major depression, based on the presence of a personality disorder, a low self-esteem and a low satisfaction with social support. Objective: To evaluate more in depth both personality disorders and psychosocial variables as predictors of outcome. Methods: A prospective study on 57 consecutive outpatients with major depressive episodes were followed-up monthly during one year. Clinical and psychosocial variables were registered, including personality (DSM-IV criteria and IPDE structured interview), previous quality of life, self-esteem, social support and dyadic adjustment. Remission was defined as a HDS score less than 8. Univariate and multivariate (logistic regression) analyses were applied. Results: 68% of the patients reached remission at 12 months. Personality disorder (diagnosed clinically but not according to IPDE), and previous quality of life were the variables more consistently associated to remission at 12 months. Among follow-up variables, remission at 3 months was strongly associated with remission. Conclusions: Our findings confirm the importance of the clinical diagnosis of personality disorder in the major depression outcome. However, more studies are needed to clarify the divergence between clinical and structured interview guided diagnosis. With the exception of quality of life, psychosocial variables had a weak and non consistent relationship with outcome.

Collaborative Care Model to Improve Outcomes in Major Depression

AbstractOBJECTIVE:To develop a pharmacist intervention to improve depression care and outcomes within a primary care setting.METHODS:Pragmatic, randomized trial of a clinical pharmacist collaborative care intervention versus usual care in a busy, academic family practice clinic.RESULTS:Seventy-four patients diagnosed with a new episode of major depression and started on antidepressant medications were randomized to enhanced care (EC) or usual care (UC) groups. EC consists of a clinical pharmacist collaborating with primary care providers (PCPs) to facilitate education, initiation, and titration of acute-phase antidepressant treatment to monitor treatment adherence and to prevent relapse. Control patients receive UC by their PCP. The main end point is reduction of depression symptoms over time as measured by the Hopkins Symptom Checklist (SCL-20). Other outcomes include the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV) criteria for major depression, health-related quality of life measured by the Medical Outcomes Study Short Form 12 (SF-12), medication adherence, patient satisfaction, and healthcare utilization. The main end point and the cost of treating major depression will be used to estimate the cost-effectiveness of the collaborative care model.CONCLUSIONS:The study is a unique, ongoing trial that may have important implications for the treatment of depression in primary care settings as well as new roles for clinical pharmacists. ResumenOBJETIVO:Evaluar la intervención farmacéutica para mejorar el cuidado y los resultados del tratamiento de la depresión en un escenario de cuidado primario.MÉTODOS:Estudio pragmático aleatoreo de las intervenciones colaborativas de un farmacéutico clínico versus el cuidado usual brindado, llevado a cabo en una clínica académica de medicina de familia de mucho trabajo.RESULTADOS:Setenta y cuatro pacientes diagnosticados con un episodio nuevo de depresión mayor y comenzados en antidepresivos fueron asignados aleatoreamente a grupos de cuidado aumentado (CA) o cuidado usual (CU). CA consistía en que el farmacéutico clínico colaboraba con proveedores de cuidado primario (PCP) para facilitar la educación, iniciar y ajustar dosis en la fase aguda del tratamiento con antidepresivos, dar seguimiento a la adherencia del paciente con su tratamiento, y prevenir relapsos. Los pacientes en el grupo control recibieron el CU de su PCP. La meta principal fue la reducción de los síntomas de depresión a través del tiempo, medidos por la Lista de Cotejo de Síntomas de Hopkins (SCL-20). Otras medidas incluyeron el criterio de DSM-IV para depresión mayor, la calidad de vida relacionada con la salud, medida por la Forma Corta del Estudio de los Resultados Médicos 12 (SF-12), la adherencia al régimen, la satisfacción de los pacientes, y la utilización de los servicios para el cuidado de la salud. La meta principal y el costo de tratar la depresión mayor serán utilizados para estimar la costo efectividad de este modelo de cuidado colaborativo.CONCLUSIONES:Este es un estudio único que se está llevando a cabo y podría tener implicaciones importantes en el tratamiento de la depresión en un escenario de cuidado primario, así como nuevas funciones para el farmaceútico clínico. RésuméOBJECTIF:Évaluer l'impact de l'intervention d'un pharmacien afin d'améliorer les soins associés au traitement de la dépression. Les auteurs présentent le devis expérimental utilisé pour mener cette étude.DEVIS EXPÉRIMENTAL:Étude aléatoire évaluant les interventions d'un pharmacien clinicien dans le traitement de la dépression dans une clinique de médecine familiale universitaire.RÉSULTATS:Présentement 74 patients avec un diagnostic d'un nouvel épisode de dépression majeure et ayant débuté un traitement avec antidépresseur ont été randomisés dans 2 groupes: soit un groupe avec soins augmentés et un groupe avec soins usuels. Dans le groupe recevant les soins augmentés, le pharmacien clinicien collabore avec les autres professionnels de la santé au niveau de l'information sur la dépression, le début et l'augmentation des posologies des antidépresseurs dans la phase aiguë, la fidélité au traitement, et la prévention des rechutes. Les patients dans le groupe contrôle recevaient des soins usuels pris en charge par les différents professionnels de la santé. l'objectif primaire de l'étude est la réduction des symptômes associés à la dépression mesurée par l'échelle des symptômes de Hopkins (SCL-20). Les objectifs secondaires incluent les critères de dépression du DSM-IV, l'échelle de qualité de vie mesurée par le formulaire court Medical Outcomes Study (SF-12), la fidélité au traitement, la satisfaction des patients, et l'utilisation des soins de santé.CONCLUSIONS:Cette étude est présentement en cours et devrait ětre complétée durant l'année 2002. Les résultats de cette étude pourraient avoir des implications importantes dans le traitement et le suivi de la dépression chez les patients suivis dans les cliniques de médecine familiale. Un nouveau rôle du pharmacien pourrait également ětre défini.