Several brief office visits along with continuing telephone calls or even e-mailed notes can help prevent relapse into depression among patients known to be at risk. A University of Washington study showed that interventions spaced throughout a 12-month follow-up period after an acute episode helped patients at risk of a relapse into major depression, also known as dysthymia, show a significant improvement in their adherence to an anti-depressant medication program.
Dr. Wayne Katon, a UW professor of psychiatry and behavioral sciences, and Dr. Michael Von Korff of the Center for Health Studies at Group Health Cooperative and their colleagues said the intervention program also improved depressive symptom outcomes over the 12-month period of the study.
Researchers for many other chronic diseases, such as diabetes and asthma, are finding that phone or even e-mail interventions can be effective ways to improve patient adherence to treatment plans, Katon said.
“We’ve found that our patients actually like using the telephone this way, as follow-up on their clinical treatment,” Katon said. “It’s the convenience. We’re finding that patients actually are more satisfied with these interventions. They get closer contact than usually occurs in the typical course of care for depression.”
The randomized trial described in the March 15, 2001 issue of the Archives of General Psychiatry studied 386 patients. The Group Health Cooperative patients had largely recovered from major depression or dysthymia after eight weeks of treatment with anti-depressant treatment by the primary care physicians. The patients in this population were considered at high risk to relapse into major depression. Half the patients received the usual follow-up care, as the study’s control group. The patients in the intervention group received two primary care visits with a depression specialist and 3 telephone visits over a 1-year period. This intervention was aimed at enhancing adherence to antidepressant medication, recognition of early symptoms, monitoring symptoms, and development of a written relapse-prevention plan.
“It’s a very brief intervention,” Katon said. “The positive side to this is that almost all the patients we approached agreed to this intervention.”
Katon also said that the patients who enrolled in the trial tended to be representative of most people who are at risk of relapse into depression. Previous studies have focused on people with recurrent depression or dysthymia who are willing or able to give up large amounts of time for treatment visits to a specialist’s office. This willingness makes these patients different from the majority of people who need relapse prevention.
Patients who received usual follow-up care typically received prescriptions for antidepressant medication, two to four visits to the primary care clinic over the first six months of treatment and the option of a referral to a Group Health mental health provider. Patients in both the control group and the study group had that option.
Katon noted that this study was the first primary care-based effectiveness study of trying to prevent relapse in depression patients.
“This study was unique in that it was done in a primary care setting, with people being treated by primary care physicians,” Katon said. “The other difference was in the use of briefer interventions. Rather than setting up multiple office visits, as is done for depression patients in efficacy studies, we focused on briefer meetings but long-term interventions in a wider range of patients. Efficacy trials tend to include a narrower range of patients who have more severe problems with depression.”
He added that many victims of depression are so busy that traveling repeatedly to a doctor’s office simply isn’t feasible.
“Since most of the self-care for chronic conditions occurs at home,” Katon said, “telephone monitoring, advice, education and support may be very effective in changing health habits. These are very hard to change for all of us.”
Group Health Cooperative, the site of this study, is a Seattle-based health system.