Is Remission of Depressive Symptoms in Primary Care a Realistic Goal? A Meta-analysis

Overview

Journal BMC Fam Pract

Publisher Biomed Central

Specialties Health Services
Public Health

Date 2004 Sep 9

PMID 15353006

Citations 11

Authors

Marliese Y Dawson

Erin E Michalak

Paul Waraich

J Ellen Anderson

Raymond W Lam

Affiliations

Soon will be listed here.

Abstract

Background: A primary goal of acute treatment for depression is clinical remission of symptoms. Most meta-analyses of remission rates involve randomized controlled trials (RCTs) using patients from psychiatric settings, but most depressed patients are treated in primary care. The goal of this study was to determine remission rates obtained in RCTs of treatment interventions for Major Depressive Disorder (MDD) conducted in primary care settings.

Methods: Potentially relevant studies were identified using computerized and manual search strategies up to May 2003. Criteria for inclusion included published RCTs with a clear definition of remission using established outcome measures.

Results: A total of 13 studies (N = 3202 patients) meeting inclusion criteria were identified. Overall remission rates for active interventions ranged between 50% and 67%, compared to 32% for pill placebo conditions and 35% for usual care conditions.

Conclusions: Remission rates in primary care studies of depression are at least as high as for those in psychiatric settings. It is a realistic goal for family physicians to target remission of symptoms as an optimal outcome for treatment of depression.

Citing Articles

Optimizing and Predicting Antidepressant Efficacy in Patients with Major Depressive Disorder Using Multi-Omics Analysis and the Opade AI Prediction Tools.

Corrivetti G, Monaco F, Vignapiano A, Marenna A, Palm K, Fernandez-Arroyo S Brain Sci. 2024; 14(7).

PMID: 39061399 PMC: 11275115. DOI: 10.3390/brainsci14070658.

Predictors of Remission in Acute and Continuation Treatment of Depressive Disorders.

Kim H, Lee H, Jhon M, Kim J, Kang H, Lee J Clin Psychopharmacol Neurosci. 2021; 19(3):490-497.

PMID: 34294617 PMC: 8316666. DOI: 10.9758/cpn.2021.19.3.490.

Low emotion-oriented coping and informal help-seeking behaviour as major predictive factors for improvement in major depression at 5-year follow-up in the adult community.

Rodgers S, Vandeleur C, Strippoli M, Castelao E, Tesic A, Glaus J Soc Psychiatry Psychiatr Epidemiol. 2017; 52(9):1169-1182.

PMID: 28748306 DOI: 10.1007/s00127-017-1421-x.

Bouncing back: remission from depression in a 12-year panel study of a representative Canadian community sample.

Fuller-Thomson E, Battiston M, Gadalla T, Brennenstuhl S Soc Psychiatry Psychiatr Epidemiol. 2014; 49(6):903-10.

PMID: 24401913 DOI: 10.1007/s00127-013-0814-8.

Efficacy of individualized homeopathic treatment and fluoxetine for moderate to severe depression in peri- and postmenopausal women (HOMDEP-MENOP): study protocol for a randomized, double-dummy, double-blind, placebo-controlled trial.

Macias-Cortes E, Aguilar-Faisal L, Asbun-Bojalil J Trials. 2013; 14:105.

PMID: 23782520 PMC: 3748824. DOI: 10.1186/1745-6215-14-105.

References

Gath D, Day A, Baker F . Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care. BMJ. 2000; 320(7226):26-30. PMC: 27250. DOI: 10.1136/bmj.320.7226.26. View

Katon W, von Korff M, Lin E, Simon G, Walker E, Unutzer J . Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Arch Gen Psychiatry. 1999; 56(12):1109-15. DOI: 10.1001/archpsyc.56.12.1109. View

Katzelnick D, Simon G, Pearson S, Manning W, Helstad C, Henk H . Randomized trial of a depression management program in high utilizers of medical care. Arch Fam Med. 2000; 9(4):345-51. DOI: 10.1001/archfami.9.4.345. View

Judd L, Paulus M, Schettler P, Akiskal H, Endicott J, Leon A . Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness?. Am J Psychiatry. 2000; 157(9):1501-4. DOI: 10.1176/appi.ajp.157.9.1501. View

Benkert O, Szegedi A, Kohnen R . Mirtazapine compared with paroxetine in major depression. J Clin Psychiatry. 2000; 61(9):656-63. DOI: 10.4088/jcp.v61n0911. View

Dowrick C, Dunn G, Ayuso-Mateos J, Dalgard O, Page H, Lehtinen V . Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. Outcomes of Depression International Network (ODIN) Group. BMJ. 2000; 321(7274):1450-4. PMC: 27549. DOI: 10.1136/bmj.321.7274.1450. View

Thase M, Entsuah A, Rudolph R . Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry. 2001; 178:234-41. DOI: 10.1192/bjp.178.3.234. View

Chilvers C, Dewey M, Fielding K, Gretton V, Miller P, Palmer B . Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms. BMJ. 2001; 322(7289):772-5. PMC: 30555. DOI: 10.1136/bmj.322.7289.772. View

Parikh S, Lam R . Clinical guidelines for the treatment of depressive disorders, I. Definitions, prevalence, and health burden. Can J Psychiatry. 2001; 46 Suppl 1:13S-20S. View

10.

Reesal R, Lam R . Clinical guidelines for the treatment of depressive disorders. II. Principles of management. Can J Psychiatry. 2001; 46 Suppl 1:21S-28S. View

11.

Thase M . The clinical, psychosocial, and pharmacoeconomic ramifications of remission. Am J Manag Care. 2001; 7(11 Suppl):S377-85. View

12.

Wade A, Michael Lemming O, Bang Hedegaard K . Escitalopram 10 mg/day is effective and well tolerated in a placebo-controlled study in depression in primary care. Int Clin Psychopharmacol. 2002; 17(3):95-102. DOI: 10.1097/00004850-200205000-00001. View

13.

Smith D, Dempster C, Glanville J, Freemantle N, Anderson I . Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: a meta-analysis. Br J Psychiatry. 2002; 180:396-404. DOI: 10.1192/bjp.180.5.396. View

14.

Kutcher S, LeBlanc J, MacLaren C, Hadrava V . A randomized trial of a specific adherence enhancement program in sertraline-treated adults with major depressive disorder in a primary care setting. Prog Neuropsychopharmacol Biol Psychiatry. 2002; 26(3):591-6. DOI: 10.1016/s0278-5846(01)00313-x. View

15.

Casacalenda N, Perry J, Looper K . Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy, and control conditions. Am J Psychiatry. 2002; 159(8):1354-60. DOI: 10.1176/appi.ajp.159.8.1354. View

16.

Rost K, Nutting P, Smith J, Elliott C, Dickinson M . Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care. BMJ. 2002; 325(7370):934. PMC: 130058. DOI: 10.1136/bmj.325.7370.934. View

17.

Fava G, Fabbri S, Sonino N . Residual symptoms in depression: an emerging therapeutic target. Prog Neuropsychopharmacol Biol Psychiatry. 2002; 26(6):1019-27. DOI: 10.1016/s0278-5846(02)00226-9. View

18.

Bauer M, Whybrow P, Angst J, Versiani M, Moller H . World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 1: Acute and continuation treatment of major depressive disorder. World J Biol Psychiatry. 2002; 3(1):5-43. DOI: 10.3109/15622970209150599. View

19.

Cuffel B, Azocar F, Tomlin M, Greenfield S, Busch A, Croghan T . Remission, residual symptoms, and nonresponse in the usual treatment of major depression in managed clinical practice. J Clin Psychiatry. 2003; 64(4):397-402. DOI: 10.4088/jcp.v64n0406. View

20.

Zimmerman M, Posternak M, Chelminski I . Implications of using different cut-offs on symptom severity scales to define remission from depression. Int Clin Psychopharmacol. 2004; 19(4):215-20. DOI: 10.1097/01.yic.0000130232.57629.46. View