August 01, 2019
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Remission rates high among patients with multiple follow-up visits for depression

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High remission rates were observed in patients with three or more follow-up visits after routine depression screening and treatment, according to findings recently published in Annals of Family Medicine.

“Current estimates suggest that even among treatment-seeking depressed outpatients, over one-fourth drop out of care during initial acute-phase antidepressant treatment,” Manish K. Jha, MD, of the Center for Depression Research and Clinical Care at the University of Texas Southwestern Medical Center, and colleagues wrote. “Estimates suggest that less than 6% of depressed patients attain remission in community settings.”

Researchers utilized VitalSign6 — a software program that utilizes the PHQ-9 screening tool and supports treatment decisions — on a convenience sample of 25,000 patients (mean age, 40.88 years) who were previously screened with the PHQ-2.

Jha and colleagues found that 2,160 of these patients screened positive for depression, had a clinician-diagnosed depressive disorder and enrolled in the study for at least 18 weeks. Of the 1,400 patients that began pharmacotherapy, 45.5% had no follow-up visit, 30.2% had one follow-up visit (remission rate = 20.3%), 12.6% had two or more follow-up visits (remission rate = 31.6%) and 11.6% had three or more follow-up visits (remission rate = 41.7%).

In addition, patients with higher attrition rates were more likely to be nonwhite, younger, screen positive for drug-abuse and have less severe depression/anxiety symptoms, according to researchers.

“These rates were comparable to the large-scale Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (27.5% remission rate after level 1 based on Hamilton Rating Scale for Depression severity), and superior to the reported remission rate of 15% with first antidepressant treatment in psychiatric practices at large academic centers,” Jha and colleagues wrote.

The new findings suggest that primary care physicians need to screen patients for depression, study co-author Madhukar Trivedi, MD, of the Center for Depression Research and Clinical Care at the University of Texas Southwestern Medical Center told Healio Primary Care.

“The growing concern for undetected and untreated depression in medical settings has led to the recommendations for universal screening for depression in the general adult populations. However, depression is still highly stigmatized in our society,” Trivedi said.

“For change to occur, PCPs should begin to view and address depression like any other chronic medical illness such as diabetes or hypertension. The adoption of VitalSign6 in primary care settings has demonstrated that it has the potential to increase detection of depression, improve access to care for patients, and results in high remission rates, which significantly reduces the burden of the disease,” he added. – by Janel Miller

Disclosures: Jha and Trivedi report conducting contract research work for pharmaceutical companies. Please see the study for all other authors’ relevant financial disclosures.