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Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years.
J Fam Pract 2001; 50(5):405-12JF

Abstract

OBJECTIVE

The researchers evaluated the effectiveness of paroxetine and Problem-Solving Treatment for Primary Care (PST-PC) for patients with minor depression or dysthymia.

STUDY DESIGN

This was an 11-week randomized placebo-controlled trial conducted in primary care practices in 2 communities (Lebanon, NH, and Seattle, Wash). Paroxetine (n=80) or placebo (n=81) therapy was started at 10 mg per day and increased to a maximum 40 mg per day, or PST-PC was provided (n=80). There were 6 scheduled visits for all treatment conditions.

POPULATION

A total of 241 primary care patients with minor depression (n=114) or dysthymia (n=127) were included. Of these, 191 patients (79.3%) completed all treatment visits.

OUTCOMES

Depressive symptoms were measured using the 20-item Hopkins Depression Scale (HSCL-D-20). Remission was scored on the Hamilton Depression Rating Scale (HDRS) as less than or equal to 6 at 11 weeks. Functional status was measured with the physical health component (PHC) and mental health component (MHC) of the 36-item Medical Outcomes Study Short Form.

RESULTS

All treatment conditions showed a significant decline in depressive symptoms over the 11-week period. There were no significant differences between the interventions or by diagnosis. For dysthymia the remission rate for paroxetine (80%) and PST-PC (57%) was significantly higher than for placebo (44%, P=.008). The remission rate was high for minor depression (64%) and similar for each treatment group. For the MHC there were significant outcome differences related to baseline level for paroxetine compared with placebo. For the PHC there were no significant differences between the treatment groups.

CONCLUSIONS

For dysthymia, paroxetine and PST-PC improved remission compared with placebo plus nonspecific clinical management. Results varied for the other outcomes measured. For minor depression, the 3 interventions were equally effective; general clinical management (watchful waiting) is an appropriate treatment option.

Authors+Show Affiliations

Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03755, USA. James.Barrett@Dartmouth.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11350703

Citation

Barrett, J E., et al. "Treatment of Dysthymia and Minor Depression in Primary Care: a Randomized Trial in Patients Aged 18 to 59 Years." The Journal of Family Practice, vol. 50, no. 5, 2001, pp. 405-12.
Barrett JE, Williams JW, Oxman TE, et al. Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years. J Fam Pract. 2001;50(5):405-12.
Barrett, J. E., Williams, J. W., Oxman, T. E., Frank, E., Katon, W., Sullivan, M., ... Sengupta, A. S. (2001). Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years. The Journal of Family Practice, 50(5), pp. 405-12.
Barrett JE, et al. Treatment of Dysthymia and Minor Depression in Primary Care: a Randomized Trial in Patients Aged 18 to 59 Years. J Fam Pract. 2001;50(5):405-12. PubMed PMID: 11350703.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years. AU - Barrett,J E, AU - Williams,J W,Jr AU - Oxman,T E, AU - Frank,E, AU - Katon,W, AU - Sullivan,M, AU - Hegel,M T, AU - Cornell,J E, AU - Sengupta,A S, PY - 2001/01/29/received PY - 2001/01/29/revised PY - 2001/5/15/pubmed PY - 2001/7/13/medline PY - 2001/5/15/entrez SP - 405 EP - 12 JF - The Journal of family practice JO - J Fam Pract VL - 50 IS - 5 N2 - OBJECTIVE: The researchers evaluated the effectiveness of paroxetine and Problem-Solving Treatment for Primary Care (PST-PC) for patients with minor depression or dysthymia. STUDY DESIGN: This was an 11-week randomized placebo-controlled trial conducted in primary care practices in 2 communities (Lebanon, NH, and Seattle, Wash). Paroxetine (n=80) or placebo (n=81) therapy was started at 10 mg per day and increased to a maximum 40 mg per day, or PST-PC was provided (n=80). There were 6 scheduled visits for all treatment conditions. POPULATION: A total of 241 primary care patients with minor depression (n=114) or dysthymia (n=127) were included. Of these, 191 patients (79.3%) completed all treatment visits. OUTCOMES: Depressive symptoms were measured using the 20-item Hopkins Depression Scale (HSCL-D-20). Remission was scored on the Hamilton Depression Rating Scale (HDRS) as less than or equal to 6 at 11 weeks. Functional status was measured with the physical health component (PHC) and mental health component (MHC) of the 36-item Medical Outcomes Study Short Form. RESULTS: All treatment conditions showed a significant decline in depressive symptoms over the 11-week period. There were no significant differences between the interventions or by diagnosis. For dysthymia the remission rate for paroxetine (80%) and PST-PC (57%) was significantly higher than for placebo (44%, P=.008). The remission rate was high for minor depression (64%) and similar for each treatment group. For the MHC there were significant outcome differences related to baseline level for paroxetine compared with placebo. For the PHC there were no significant differences between the treatment groups. CONCLUSIONS: For dysthymia, paroxetine and PST-PC improved remission compared with placebo plus nonspecific clinical management. Results varied for the other outcomes measured. For minor depression, the 3 interventions were equally effective; general clinical management (watchful waiting) is an appropriate treatment option. SN - 0094-3509 UR - https://www.unboundmedicine.com/medline/citation/11350703/Treatment_of_dysthymia_and_minor_depression_in_primary_care:_a_randomized_trial_in_patients_aged_18_to_59_years_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=11350703.ui DB - PRIME DP - Unbound Medicine ER -