Management of treatment-resistant depression in primary care: a mixed-methods study

Wiles, N. et al. (2018) Management of treatment-resistant depression in primary care: a mixed-methods study. British Journal of General Practice, 68(675), e673-e681. (doi: 10.3399/bjgp18X699053) (PMID:30249609) (PMCID:PMC6145970)

Abstract

Background: Non-response to antidepressant medication is common in primary care. Little is known about how GPs manage patients with depression that does not respond to medication. Aim: To describe usual care for primary care patients with treatment-resistant depression (TRD). Design and setting: Mixed-methods study using data from a UK primary care multicentre randomised controlled trial. Method: In total, 235 patients with TRD randomised to continue with usual GP care were followed up at 3-month intervals for a year. Self-report data were collected on antidepressant medication, number of GP visits, and other treatments received. In addition, 14 semi-structured face-to-face interviews were conducted with a purposive sample after the 6-month follow-up and analysed thematically. Results: Most patients continued on the same dose of a single antidepressant between baseline and 3 months (n = 147/186 at 3 months, 79% (95% confidence interval [CI] = 73 to 85%)). Figures were similar for later follow-ups (for example, 9–12 months: 72% (95% CI = 63 to 79%). Medication changes (increasing dose; switching to a different antidepressant; adding a second antidepressant) were uncommon. Participants described usual care mainly as taking antidepressants, with consultations focused on other (physical) health concerns. Few accessed other treatments or were referred to secondary care. Conclusion: Usual care in patients with TRD mainly entailed taking antidepressants, and medication changes were uncommon. The high prevalence of physical and psychological comorbidity means that, when these patients consult, their depression may not be discussed. Strategies are needed to ensure the active management of this large group of patients whose depression does not respond to antidepressant medication.

• Item Type: Articles
• Additional Information: The CoBalT study was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number: 06/404/02).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Morrison, Professor Jill
• Authors: Wiles, N., Taylor, A., Turner, N., Barnes, M., Campbell, J., Lewis, G., Morrison, J., Peters, T. J., Thomas, L., Turner, K., and Kessler, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Journal Name: British Journal of General Practice
• Publisher: Royal College of General Practitioners
• ISSN: 0960-1643
• ISSN (Online): 1478-5242
• Published Online: 28 September 2018
• Copyright Holders: Copyright © British Journal of General Practice 2018
• First Published: First published in British Journal of General Practice 68(675):e673-e681
• Publisher Policy: Reproduced under a Creative Commons license