Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. I. Classification, burden and principles of management.

A Randomized, Placebo-Controlled, Active-Reference, Double-Blind, Flexible-Dose Study of the Efficacy of Vortioxetine on Cognitive Function in Major Depressive Disorder

Structural and cognitive deficits in remitting and non-remitting recurrent depression: a voxel-based morphometric study.

Depression is a relatively common clinical disorder and can be difficult to effectively treat according to findings from the Sequenced Treatment Alternatives to Relieve Depression study. Given this working terrain, patient adherence with antidepressant therapy is a critical aspect of effective clinical management. However, according to contemporary data (i.e., over the past 10 years), approximately 50 percent of psychiatric patients and 50 percent of primary care patients prematurely discontinue antidepressant therapy (i.e., are nonadherent when assessed at six-months after the initiation of treatment). The reasons behind patient nonadherence to antidepressants are varied and include both patient factors (e.g., concerns about side effects, fears of addiction, belief that these medications will not really address personal problems) as well as clinician factors (e.g., lack of sufficient patient education, poor follow-up). An awareness of the high rates of antidepressant nonadherence among patients hopefully will underscore to the prescriber the importance of carefully exploring patient concerns about these medications and closely monitoring patients while on therapy.

Antidepressant adherence: are patients taking their medications?

ObjectiveThis multicenter study compared the relapse and recurrence outcomes of two active treatments, maintenance cognitive-behavioral therapy (CBT) and manualized psychoeducation, both in addition to treatment as usual, in patients in remission from depression.MethodThis was a multicenter prospective randomized observer-blinded study with two parallel groups. The authors assessed 180 patients with three or more previous major depressive episodes who met remission criteria over a 2-month baseline period and who were randomly assigned to 16 sessions of either maintenance CBT or manualized psychoeducation over 8 months and then followed up for 12 months. The main outcome measure was time to first relapse or recurrence of a major depression, based on DSM-IV criteria, as assessed by blinded observers with the Longitudinal Interval Follow-Up Evaluation.ResultsCox regression analysis showed that time to relapse or recurrence of major depression did not differ significantly between treatment conditions, but a s...

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2013.12060734

Maintenance cognitive-behavioral therapy and manualized psychoeducation in the treatment of recurrent depression: a multicenter prospective randomized controlled trial

Major depressive disorder (MDD) is often a chronic, recurrent, and debilitating disorder with a lifetime prevalence of 16.2% and a 12-month prevalence of 6.6% in the United States. The disorder is associated with high rates of comorbidity with other psychiatric disorders and general medical illnesses, lower rates of adherence to medication regimens, and poorer outcomes for chronic physical illness. While 51.6% of cases reporting MDD received health care treatment for the illness, only 21.7% of all MDD cases received minimal guideline-level treatment. Because the overwhelming majority of patients with depressive disorders are seen annually by their primary care physicians, the opportunity to diagnose and treat patients early in the course of their illness in the primary care setting is substantial, though largely unfulfilled by our current health care system. The goal of treatment is 2-fold: early and complete remission of symptoms of depression and eventual recovery to premorbid levels of functioning in response to acute-phase treatment, and prevention of relapse during the continuation phase or recurrence during the maintenance phase. However, only 25% to 50% of patients with MDD adhere to their antidepressant regimen for the length of time recommended by depression guidelines, and nearly 50% of depressed patients referred from primary care to specialty care treatment fail to complete the referral. Patients with chronic or treatment-resistant depression often require multiple trials using an algorithm-based approach involving more than one treatment strategy. Under conditions of usual care, 40% to 44% of patients with MDD treated with antidepressants in the primary care setting show a >or=50% improvement in depression scores at 4-month follow-up, compared with 70% to 75% of those treated using collaborative care models. This demonstrates the importance of factors other than antidepressant medication per se for achieving treatment effectiveness. Additional research is needed to evaluate longer-term outcomes of algorithm-based, stepped, collaborative care models that incorporate patient self-management in conjunction with usual care. Furthermore, the health care system must undergo major transformation to effectively treat depression, along with other chronic illnesses. The use of evidence-based treatment algorithms are discussed and recommendations are provided for patients and physicians based on collaborative care interventions that may be useful for improving the current management of depressive disorders.

Wayne J. Katon

Papers

Consensus recommendations for improving adherence, self-management, and outcomes in patients with depression.