Remission, Residual Symptoms, and Nonresponse in the Usual Treatment of Major Depression in Managed Clinical Practice. [CME]
J Clin Psychiatry 2003;64(4):397-402
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Although published guidelines
recommend the continuation of treatment for depression until full
remission of symptoms and restoration of functioning, little is
known about how often remission is achieved in usual practice and
the precipitants of treatment termination when treatment outcome
has not been optimal.
Method: A naturalistic study design examined
1859 patients receiving treatment for DSM-III-R major depression
between 1995 and 1997 in the national provider network of a
managed behavioral health organization (MBHO). Symptom and
impairment ratings by clinicians were used to group patients into
full remission, partial remission, and no response. Claims data
were used to characterize treatment and identify comorbid medical
Results: According to clinician ratings,
approximately 27% to 39% of patients achieved full remission.
Medical and substance use comorbidity and hospital admission were
more common in those with a partial response to treatment. Only
half of patients without a treatment response received a trial of
medication during their treatment. Patient choice was the most
common reason for termination of treatment, although nearly 40%
of clinicians concurred with patients' decisions even when
symptoms had not improved.
Conclusion: Although rates of full remission
were comparable to those in clinical trials of antidepressants,
results suggest that clinicians may fail to recommend
continuation and maintenance treatment consistent with best
practice guidelines and that unsuccessful treatment often does
not include antidepressant medication.