Fighting the Blues Was a Winning Battle

Antidepressants and psychotherapy given in primary care settings for depression were effective

(RxWiki News) When a period of feeling blue gets worse or doesn't go away, you may be depressed. Getting effective treatment can be the key to your recovery.

New reviews on depression research found that tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) worked effectively for patients who were treated by their primary care doctors. These study authors also found that depression improved in patients if their primary care doctor treated them with psychotherapy.

"This [latter] finding is reassuring for both patients and clinicians wishing to pursue [non-medication] options," the authors of these reviews wrote.

Jinju Weiss, DO, of Baylor Medical Center at McKinney and Baylor Family Medicine at Aubrey, told dailyRx News that primary care doctors can address depression in their patients by "recognising signs and symptoms of depression and having open and frank discussions with their patients.

"Primary care doctors are confronted on a frequent basis with the signs and symptoms of depression some subtle and some overt," said Dr. Weiss, who was not involved in these reviews.

"As a result, primary care physician become the first lines to appropriately diagnose and begin treatment. The treatment modality should be carried out on a case by case basis depending on the needs of the patient, whether pharmacologic, counseling, psychotherapy, cognitive behavioural therapy or a combination. If the patient doesn't respond to the treatment modalities then a referral to a higher level of care should be considered," she said.

These two reviews were written by a research team from Germany. Klaus Linde, MD, of the Institute of General Practice at Technische Universität München in Munich, was the lead author on the reviews.

One review analyzed results of 66 studies that involved more than 15,000 patients. These patients with depression were treated by their primary care doctor with medication.

The second review of 30 studies involving more than 5,000 patients dealt with the effectiveness of different psychological treatments for depression. These treatments were also given in a primary care setting.

Dr. Linde and team found that both medication and psychotherapy given in the primary care setting improved patients' depression symptoms.

Depression improved most in patients treated with TCAs or SSRIs. Norpramin and Tofranil are brand names of TCAs. Celexa, Prozac, Lexapro, Zoloft and Paxil are brand names of SSRIs.

These studies showed that depression improved in people taking SSRIs — compared to those who took a placebo (fake pill). Similar results were seen in patients treated with TCAs.

Cognitive behavioral therapy (CBT) given by primary care doctors improved patients' depression, but this improvement was small. The results were the same if the therapy was given in the doctor's office or remotely, such as over the phone or on the computer.

CBT is designed to help patients recognize situations that cause certain reactions and to teach them to respond in a way that is better for their mental health.

Frank V. deGruy, MD, of the University of Colorado in Denver, wrote an editorial in response to the reviews by Dr. Linde and colleagues.

Dr. deGruy said psychotherapy is time-consuming and may be tough to fit into a patient's visit.

Dr. deGruy continued, "We are becoming familiar with implementation issues in primary care as we attempt to transform our clinics to better manage patients’ chronic diseases, to become patient-centered medical homes, to practice team-based care, or to continuously improve the quality of the care we render."

The reviews and editorial were published online Jan. 12 in the Annals of Family Medicine.

A grant from the German Ministry of Education and Research funded this research. The authors disclosed no conflicts of interest.

Review Date: 
January 9, 2015