Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-24T11:46:46.869Z Has data issue: false hasContentIssue false
  • English
  • Français

Medication received by patients with depression following the acute episode: adequacy and relation to outcome

Published online by Cambridge University Press:  02 January 2018

Rajini Ramana ,
Eugene S. Paykel ,
Paul G. Surtees ,
David Melzer  and
Mitul A. Mehta
Rajini Ramana*
Affiliation:
Fulbourn Hospital, Fulboum, Cambridge
Eugene S. Paykel
Affiliation:
University of Cambridge, Addenbrooke's Hospital, Cambridge
Paul G. Surtees
Affiliation:
MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Forvie Site, Addenbrooke's Hospital, Cambridge
David Melzer
Affiliation:
Department of Community Medicine, Institute of Public Health, University of Cambridge
Mitul A. Mehta
Affiliation:
Department of Psychiatry, University of Cambridge
*
Rajini Ramana, Fulbourn Hospital. Fulbourn, Cambridge CB1 5EF
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The adequacy of pharmacotherapy received in practice by patients after an acute episode of depression has been little studied.

Aims

To describe and assess adequacy of drug continuation and maintenance in patients with depression.

Method

Patients with depression were interviewed 18 months after discharge from hospital. Quantitative assessments of drug treatment doses and compliance were made monthly over this period, and qualitative ratings in continuation and maintenance phases.

Results

About 20% of patients were prescribed low drug doses after discharge and 10% were prescribed no drugs at all. Reported compliance was around 70%. About 30% failed to receive adequate longer-term treatment, mostly due to the continuation phase being too short. Deficiencies of dosage and compliance were greater in patients who never achieved full recovery. Patient refusal was the most common reason for not using antidepressants. Further episodes of depression were not particularly associated with inadequate treatment.

Conclusions

There were deficiencies in drug treatment that did not appear to be the principal cause of further episodes but may be important in non-recovery. Patient fears require discussion.

Type
Papers
Information
The British Journal of Psychiatry , Volume 174 , Issue 2 , February 1999 , pp. 128 - 134
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Declaration of interest Study supported by the East Anglian Regional Health Authority.

References

American Psychiatric Association (1993) Practice guidelines for major depressive disorder in adults. American Journal of Psychiatry, 150 (suppl. 4): 1–26.Google Scholar
British Medical Association & Royal Pharmaceutical Society of Great Britain (1998) British National Formulary. London: BMA & RPSGB.Google Scholar
Brugha, T. S. & Bebbington, P. E. (1992) The under treatment of depression. European Archives of Psychiatry and Clinical Neuroscience, 242, 105–108.Google Scholar
Dawson, R., Lavori, P. W., Coryell, W. H., et al (1998) Maintenance strategies for unipolar depression: an observational study of levels of treatment and recurrences. Journal of Affective Disorders, 49, 31–44.Google Scholar
Depression Guideline Panel (1993) Clinical Practice Guideline. Number 5. Depression in Primary Care: Volume 2. Treatment of Major Depression. Rockville, MD: Agency for Health Care Policy and Research.Google Scholar
Donoghue, J. M. & Tylee, A. (1996) The treatment of depression: prescribing patterns of primary care in the UK. British Journal of Psychiatry, 168, 164–168.Google Scholar
Fennig, S., Craig, T. J., Tanenberg-Karant, M., et al (1995) Medication treatment in first-admission patients with psychotic affective disorders: preliminary findings on research-facility diagnostic agreement and rehospitalisation. Annals of Clinical Psychiatry, 7, 87–90.Google Scholar
Frank, E., Kupfer, D. J., Perel, J. M., et al (1990) Three year outcomes for maintenance therapies of recurrent depression. Archives of General Psychiatry, 47, 1093–1099.Google Scholar
Frank, E., Prien, R. F. & Jarrett, R. B. (1991) Conceptualisation and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse and recurrence. Archives of General Psychiatry, 48, 851–855.Google Scholar
Gllck, I. D., Burti, L., Suzuki, K., et al (1991) Effectiveness in psychiatric care I: a cross-national study of the process of treatment and outcomes of major depressive disorder. Journal of Nervous and Mental Disease, 179, 55–63.Google Scholar
Goethe, J. W., Szarke, B. L. & Cook, W. L. (1988) A comparison of adequately vs inadequately treated depressed patients. Journal of Nervous and Mental Disease, 176, 465–470.CrossRefGoogle ScholarPubMed
Goodwin, G. M. (1994) Recurrence of mania after lithium withdrawal. Implications for the use of lithium in the treatment of bipolar affective disorder. British Journal of Psychiatry, 164, 149–152.Google Scholar
Johnson, D. A. W. (1973) Treatment of depression in general practice. British Medical Journal, ii, 18–20.CrossRefGoogle Scholar
Keller, M. B., Lavori, P. W., Rice, J., et al (1986a) The persistent risk of chronicity in recurrent episodes of nonbipolar major depressive disorder: a prospective follow-up. American Journal of Psychiatry, 143, 24–28.Google Scholar
Keller, M. B., Lavori, P. W., Klerman, G. L., et al (1986b) Low levels and lack of predictors of somatotherapy and psychotherapy received by depressed patients. Archives of General Psychiatry, 43, 58–466.Google Scholar
Keller, M. B., Lavori, P. W., Mueller, T. I., et al (1992) Time to recovery, chronicity, and levels of psychopathology in major depression. Archives of General Psychiatry, 49, 809–816.Google Scholar
Kiloh, L. G., Andrews, G. & Neilson, M. (1988) The long-term outcome of depressive illness. British Journal of Psychiatry, 153, 752–757.Google Scholar
Lee, A. S. & Murray, R. M. (1988) The long-term outcome of Maudsley depressives. British Journal of Psychiatry, 153, 741–751.Google Scholar
McDonald, T. M., McMahon, A. D., Reid, I. C., et al (1996) Antidepressant drug use in primary care: a record linkage study in Tayside, Scotland. British Medical Journal, 313, 860–861.Google Scholar
McElroy, S. L., Keck, P. E. Jr. Harrison, G., et al (1992) Valproate in the treatment of bipolar disorder: literature review and clinical guidelines. Journal of Clinical Psychopharmacology, 12, 425–525.Google Scholar
Mueller, T. I., Keller, M. B., Leon, A. C., et al (1996) Recovery after 5 years of unremitting major depressive disorder. Archives of General Psychiatry, 53, 794–799.Google Scholar
Paykel, E. S. (1994) The place of antidepressants in long-term treatment. In Psychopharmacology of Depression (eds Montgomery, S. A. & Corn, T. H.). British Association for Psychopharmacology Monograph No. 13. pp. 218–239. New York: Oxford University Press.Google Scholar
Paykel, E. S. & Priest, R. G. (1992) Recognition and management of depression in general practice: consensus statement. British Medical Journal, 305, 1198–1202.Google Scholar
Paykel, E. S., Ramena, R., Cooper, Z., et al (1995) Residual symptoms after partial remission: an important outcome in depression. Psychological Medicine, 25, 1171–1180.Google Scholar
Paykel, E. S., Tylee, A., Wright, A., et al (1997) The Defeat Depression Campaign: psychiatry in the public arena. American Journal of Psychiatry, 154 (festschrift suppl.), 59–65.Google Scholar
Paykel, E. S., Hart, D. & Priest, R. G. (1998) Changes in public attitudes to depression during the Defeat Depression Campaign. British Journal of Psychiatry, 173, 519–522.Google Scholar
Post, R. M. (1992) Anticonvulsants and novel drugs. In Handbook of Affective Disorders (2nd edn) (ed. Paykel, E. S.), pp. 387–418. Edinburgh: Churchill Livingstone.Google Scholar
Prien, R.F. (1992) Maintenance treatment. In Handbook of Affective Disorders (2nd edn) (ed. Paykel, E. S.), pp. 419–435. Edinburgh: Churchill Livingstone.Google Scholar
Ramana, R., Paykel, E. S., Cooper, Z., et al (1995) Remission and relapse in major depression: a two-year prospective follow-up study. Psychological Medicine, 25, 1161–1170.Google Scholar
Robinson, D. S., Lerfald, S. C., Bennet, B., et al (1991) Continuation and maintenance treatment of major depression with the monoamine oxidase inhibitor phenelzine: a double-blind placebo-controlled discontinuation study. Psychopharmacology Bulletin, 27, 31–39.Google Scholar
Simon, G. E. & Von Korff, M. (1995) Recognition, management, and outcomes of depression in primary care. Archives of Family Medicine, 4, 99–105.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry, 35, 773–782.CrossRefGoogle ScholarPubMed
Suppes, T., Baidessarini, R. J., Faedda, G. L., et al (1991) Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. Archives of General Psychiatry, 48, 1082–1088.Google Scholar
Surtees, P. G. & Barkley, C. (1994) Future imperfect: the long-term outcome of depression. British Journal of Psychiatry, 164, 327–341.CrossRefGoogle ScholarPubMed
Young, A. S., Sullivan, G., Burnam, M. A., et al (1998) Measuring the quality of outpatient treatment for schizophrenia. Archives of General Psychiatry, 55, 611–617.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.