RT Journal Article
SR Electronic
T1 Management of treatment-resistant depression in primary care: a mixed-methods study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e673
OP e681
DO 10.3399/bjgp18X699053
VO 68
IS 675
A1 Nicola Wiles
A1 Abigail Taylor
A1 Nicholas Turner
A1 Maria Barnes
A1 John Campbell
A1 Glyn Lewis
A1 Jill Morrison
A1 Tim J Peters
A1 Laura Thomas
A1 Katrina Turner
A1 David Kessler
YR 2018
UL http://bjgp.org/content/68/675/e673.abstract
AB 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.