Tarja K. Melartin, MD; Heikki J. Rytsälä, MD; Ulla S. Leskelä, MA; Paula S. Lestelä-Mielonen, MA; T. Petteri Sokero, MD; and Erkki T. Isometsä, MD, PhD
Objective: Several evidence-based treatment
guidelines for major depressive disorder (MDD) have been
published. However, little is known about how recommendations for
treatment are adhered to by patients in current usual psychiatric
practice.
Method: The Vantaa Depression Study is a
prospective, naturalistic cohort study of 269 psychiatric
patients with a new episode of DSM-IV MDD who were interviewed
with the Schedules for Clinical Assessment in Neuropsychiatry and
Structured Clinical Interview for DSM-III-R Personality Disorders
between February 1, 1997, and May 31, 1998, and again at 6 and 18
months. Treatments provided, as well as adherence to and
attitudes toward both antidepressants and psychotherapeutic
support/psychotherapy, were investigated among the 198 unipolar
patients followed for 18 months.
Results: Most depression patients (88%) received
antidepressants in the early acute phase, but about half (49%)
terminated treatment prematurely. This premature termination was
associated with worse outcome of major depressive episodes, and
with negative attitudes, mainly explained by fear of dependence
on or side effects of antidepressants. Nearly all patients (98%)
received some psychosocial treatment in the acute phase; about
one fifth (16%) had weekly psychotherapy during the follow-up.
About a quarter of patients admitted nonadherence to ongoing
treatments.
Conclusion: Problems of psychiatric care seem
most related to continuity of treatment. While adequate
treatments are provided in the early acute phase, antidepressants
are terminated too soon in about half of patients, often
following their autonomous decisions. From a secondary and
tertiary preventive point of view, improving continuity of
treatment would appear a crucial task for improving the outcome
of psychiatric patients with MDD.
J Clin Psychiatry 2005;66(2):220-227
© Copyright 2005 Physicians Postgraduate Press, Inc.