Chronic forms of major depression are still undertreated in the 21st century: Systematic assessment of 801 patients presenting for treatment

• Type of Material: Article
• Authors: James H. Kocsis, Weill-Cornell Medical Center; Alan J. Gelenberg, Health Technology Systems; Barbara Rothbaum, Emory University; Daniel N. Klein, State University of New York, Stony Brook; Madhukar H. Trivedi, University of Texas Southwestern Medical Center, Dallas; Rachel Manber, Stanford University; Martin B. Keller, Brown University; Robert Howland, University of Pittsburgh; Michael E. Thase, University of Pennsylvania
• Language: English
• Date: 2008-09-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2008 Elsevier B.V. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jad.2008.01.002
• Title of Journal or Parent Work: Journal of Affective Disorders
• ISSN: 0165-0327
• Volume: 110
• Issue: 1-2
• Start Page: 55
• End Page: 61
• Grant/Funding Information: Emory University School of Medicine (UO1 MH63481): Barbara O. Rothbaum, Ph.D.; Boadie Dunlop. M.D.; Philip T. Ninan, M.D.; Steven J. Garlow, M.D., Ph.D.; University of Pittsburgh (UO1 MH61587): Michael E. Thase, M.D.(Co-Lead PI); Edward S. Friedman, MD.; Robert H. Howland, M.D, Stephen R. Wisniewski, Ph.D.; Jennifer Barkin, M.S.; Cornell University (UO1 MH62475): James H. Kocsis, M.D.(Lead PI); John C. Markowitz, M.D.; Andrew C. Leon, Ph.D.; Richard A. Friedman, M.D.; Brown Medical School (UO1 MH61590): Martin B. Keller, M.D.; Ivan Miller, M.D.; Gabor Keitner, M.D.; Susan Raffa, Ph.D.; Grant numbers and investigators are listed below.; University of Stony Brook (UO1 MH62546): Daniel N. Klein, Ph.D.; Dina Vivian, Ph.D.; Frank Dowling, M.D.; Thomas D’Zurilla, Ph.D.; University of Arizona (U01 MH62465): Alan J. Gelenberg, M.D.; John Misiaszek, M.D.; University of Texas Southwestern Medical Center (UO1 MH MH61562): Madhukar Trivedi, M.D.; Prabha Sunderajan, M.D.; David Morris, Ph.D.; Beverly Kleiber, Ph.D.; Stanford University (UO1 MH61504): Alan F. Schatzberg, M.D.; Bruce Arnow, Ph.D.; Rachel Manber, Ph.D.; H. Brent Solvason, Ph.D., M.D.
• Keywords: Neurosciences & Neurology; PSYCHOTHERAPY; chronic; Psychiatry; Science & Technology; depression; pharmacotherapy; ADEQUACY; SERTRALINE; ELECTROCONVULSIVE-THERAPY; IMIPRAMINE; METAANALYSIS; Clinical Neurology; TRIAL; DISORDER; treatment; ANTIDEPRESSANT TREATMENT; PHARMACOTHERAPY; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Mental Health; Psychology, Clinical

Abstract

During a multisite, NIMH-sponsored clinical trial entitled, "Research Evaluating the Value of Augmentation of Medication by Psychotherapy" (REVAMP), we assessed the adequacy of prior antidepressant treatment in patients with chronic forms of major depressive disorder using the Antidepressant Treatment History Form (ATHF). We hypothesized that when compared to earlier studies treatment adequacy would not have increased over the past decade. We found that only 33% of the 801 subjects enrolled had ever had a prior adequate trial of antidepressant medication. Patients significantly more likely to have received prior adequate antidepressant trials were older, married, white, had a longer duration of illness, had more melancholic features or met criteria for the melancholic subtype or met lifetime criteria for panic disorder. The hypothesis that rates of treatment adequacy have not significantly increased over the past decade was supported. These results and the consistency of similar results over time point to the dire need for patient and provider education regarding the signs and symptoms of depression and its treatment.