Chronically depressed patients do best with individualized treatment

Improvements in chronically depressed patients can be sustained with interventions that meet a patient's needs and have flexible protocol for monitoring depression, a new study says.

But implementing such programs in primary care practices can be challenging, according to lead study author Michael Klinkman, MD. He said it takes a lot of work for physicians and their staffs to learn how to use the interventions properly.

He recommends that health professionals start by deciding on simple measures to improve their level of care for the chronically depressed. For example, he said nurses could be trained to call such patients and monitor their health.

"The bottom line is that we can do this as primary care doctors. This is achievable," said Dr. Klinkman, professor in the departments of Family Medicine and Psychiatry at the University of Michigan Health System.

"We can teach people to take better care of their depression. We can give them the skills to know when to seek care from a primary care physician, or a specialist, or when to contact a care manager. After they learn to do it, their outcomes look better for a long period of time."

Inadequate treatment of depressed patients in primary care is a major health problem, said the study, published in the September/October Annals of Family Medicine. Study authors attribute the problem, in part, to commonly used interventions that focus on short-term, rather than long-term, results (link).

Researchers analyzed data on 728 patients, 18 and older, who participated in the Depression in Primary Care intervention, which was implemented at five Michigan primary care practices in March 2002. They also examined data on 78 patients at five Michigan practices selected as usual care control sites. Patients in both groups were studied through mid-2005.

At practices with the intervention, physicians could refer depressed patients to care managers for evaluation. The care managers, who were registered nurses or had master's degrees in social work, called the referred patients and assessed their depression. When necessary, follow-up calls were made to monitor the patient and offer information on local social services or community agencies.

Researchers found that patients enrolled in the intervention generally showed less severe symptoms of depression than those in the control group during the 18-month study period. They also found that remission rates were higher for patients receiving the intervention than for people in the control group.

Staffs "have to design their practices so they can do a better job" of treating patients with chronic depression, Dr. Klinkman said.