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Research

Prevalence of treatment-resistant depression in primary care: cross-sectional data

Laura Thomas, David Kessler, John Campbell, Jill Morrison, Tim J Peters, Chris Williams, Glyn Lewis and Nicola Wiles
British Journal of General Practice 2013; 63 (617): e852-e858. DOI: https://doi.org/10.3399/bjgp13X675430
Laura Thomas
Roles: Research associate
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David Kessler
Roles: Consultant senior lecturer
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John Campbell
Roles: Professor of general practice and primary care
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Jill Morrison
Roles: Professor of general practice
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Tim J Peters
Roles: Professor of primary care health services research
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Chris Williams
Roles: Professor of psychosocial psychiatry
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Glyn Lewis
Roles: Professor of psychiatric epidemiology
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Nicola Wiles
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Abstract

Background Antidepressants are often the first-line treatment for depression in primary care. However, not all patients respond to medication after an adequate dose and duration of treatment. Currently, there are no estimates of the prevalence of treatment-resistant depression (TRD) from UK primary care.

Aim To estimate the prevalence of TRD in UK primary care.

Design and setting Data were collected as part of a multicentre randomised controlled trial, from 73 general practices in UK primary care.

Method Potential participants (aged 18–75 years who had received repeated prescriptions for antidepressants) were identified from general practice records. Those who agreed to be contacted were mailed a questionnaire that included questions on depressive symptoms (Beck Depression Inventory [BDI-II]), and adherence to antidepressants. Those who scored ≥14 on the BDI-II and had taken antidepressants for at least 6 weeks at an adequate dose were defined as treatment resistant.

Results A total of 2439 patients completed the questionnaire (84% of those who agreed to be contacted), of whom 2129 had been prescribed an adequate dose of antidepressants for at least 6 weeks. Seventy-seven per cent (95% CI = 75% to 79%) had a BDI score of ≥14. Fifty-five per cent (95% CI = 53% to 58%) (n = 1177) met the study’s definition of TRD, of whom 67% had taken their antidepressants for more than 12 months.

Conclusion The high prevalence of TRD is an important challenge facing clinicians in UK primary care. A more proactive approach to managing this patient population is required to improve outcome.

  • antidepressants
  • prevalence
  • primary health care
  • treatment resistant depression
  • Received December 20, 2012.
  • Revision received March 21, 2013.
  • Accepted May 20, 2013.
  • © British Journal of General Practice 2013
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British Journal of General Practice: 63 (617)
British Journal of General Practice
Vol. 63, Issue 617
December 2013
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Prevalence of treatment-resistant depression in primary care: cross-sectional data
Laura Thomas, David Kessler, John Campbell, Jill Morrison, Tim J Peters, Chris Williams, Glyn Lewis, Nicola Wiles
British Journal of General Practice 2013; 63 (617): e852-e858. DOI: 10.3399/bjgp13X675430

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Prevalence of treatment-resistant depression in primary care: cross-sectional data
Laura Thomas, David Kessler, John Campbell, Jill Morrison, Tim J Peters, Chris Williams, Glyn Lewis, Nicola Wiles
British Journal of General Practice 2013; 63 (617): e852-e858. DOI: 10.3399/bjgp13X675430
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Keywords

  • antidepressants
  • prevalence
  • primary health care
  • treatment resistant depression

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