View Full Version : Many patients get little or no benefit from SSRI treatment in primary care setting

09-25-04, 01:20 PM
Jun 21, 2004 A substantial number of patients treated for depression in a primary care physician (PCP) setting had only a partial response or no response to treatment with SSRIs, according to a prospective, naturalistic study reported in the Archives of Internal Medicine.

US researchers followed 482 patients (enrolled between April and November 1999) during 9 months of therapy for depression. The Randomized Trial Investigating SSRI Treatment (ARTIST) study involved 77 practitioners from 37 heterogeneous sites in one of two primary care research networks. Patients were randomly placed into one of three SSRI therapies (fluoxetine, paroxetine, or sertraline) based on the PCP's clinical judgment to initiate SSRI therapy. After placement, neither PCP nor patient were blind to the treatment group.

Overall, 64% received adequate therapy (6 months of continuous medication), 13% of patients received aggressive therapy (6 months of continuous medication, one medication switch plus one medication increase or more than one medication switch or addition of another class of medication), and 23% received inadequate therapy (medication discontinuations).

A change from baseline scores on the Symptom Checklist-20 (SCL-20) greater than the reliable change index (RCI) determined clinical response. Of patients completing 6-month evaluations, 23% were considered to be in remission (a score of 6 or less on the SCL-20), 32% were partial responders (50% decrease from baseline in SCL-20), and 46% were classified as nonresponders (meeting neither the criteria for remission nor partial response).

Initial drug randomization did not significantly affect response category. In a multiregressional analysis of baseline predictors, patient age and initial diagnostic category (major depressive disorder, dysthymia, minor depression, double depression) were significant demographic predictors of outcome.

The authors observed, "Guideline-based care suggests that most of these patients required more aggressive treatment than they obtained to achieve better outcomes. This highlights the need to redefine adequacy of treatment within the context of measured clinical improvement."