The Active Management of Depression

Culpepper, Larry

Applied Evidence

The Active Management of Depression

J Fam Pract. 2002 September;51(9):769-776

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References

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Practice strategies to improve care

A number of primary care investigators have demonstrated the value of practice management and quality improvement techniques to increase the portion of patients who achieve and maintain response to depression therapy. These studies share an approach of “active management” to promote adherence to treatment guidelines.^58-63 For instance, Simon and colleagues demonstrated the value of initial and monthly phone contact.⁶⁴

Active management techniques include the following:

Initial and ongoing patient education and counseling, as discussed above
Patient involvement and agreement in treatment choice
Initial phone contact to assure the prescription has been filled and initial dose taken
Periodic contact to inquire about adherence, treatment response, side effects, and to answer patient questions
Adjustment of therapy for those not responding adequately by 4 to 6 weeks
Establishment of a collaborative relationship with a psychiatrist for consultation and telephone advice

Additionally, primary care clinicians may find it helpful to add depression to their medical record preventive health maintenance flow chart, especially for patients with any past history of depression. Using the PHQ-9 can be beneficial in providing both the patient and physician with an objective measure of monitoring response and remission.

Conclusions

Effective and available treatments can have a major beneficial impact on patients with depression. To be maximally effective, primary care clinicians must actively manage the care of their depressed patients, using screening strategies to recognize depression in addition to targeted educational messages and active follow-up to improve treatment adherence. Long-term maintenance treatment prevents further recurrences in those who have already experienced multiple episodes. Choice of treatment should be guided by patient preference. For pharmacologic agents, selection should be based on effectiveness, likelihood of side effects and resultant premature discontinuation, and potential for drug–drug interaction. The majority of individuals with depression are managed solely in primary-care settings. With adequate treatment, remission of symptoms, significant improvement in quality of life, and return to full function at home and at work can be attained.