Depressed Primary Care Patients

Many depressed individuals are willing to accept medical treatment but not mental health treatment. Schulberg and colleagues compared IPT to nortriptyline for depressed ambulatory medical patients in a primary care setting (Schulberg etal., 1993; Schulberg & Scott, 1991). Interpersonal therapy was integrated into the routine of the primary care centre. For example, nurses took vital signs before each session and if patients were medically hospitalized, IPT was continued in the hospital when possible.

Patients with current major depression (n = 276) were randomly assigned to IPT, nortriptyline, or primary care physicians' usual care. They received 16 weekly sessions followed by four monthly sessions of IPT (Schulberg et al., 1996). Depressive symptoms improved more rapidly with IPT or nortriptyline than in usual care. About 70 % of treatment completers receiving nortriptyline or IPT recovered after eight months, compared to 20 % in usual care. This study had an odd design for treatment in the United States in bringing mental health treatment into medical clinics, but might inform treatment in the United Kingdom, where a greater proportion of antidepressant treatments are delivered in primary care settings.

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