Depression treatment should take health beliefs into account

August 20, 2000

A treatment plan for depression should include nonmedical factors based on a patient's own health beliefs, a new study reports.

"Understanding the patient factors associated with good treatment results would allow clinicians to customize depression treatments to particular patient profiles -- and thus minimize relapse or recurrence," said Charlotte Brown, PhD, of the Western Psychiatric Institute and Clinic at the University of Pittsburgh School of Medicine, in Pennsylvania, the lead author of the article appearing in the July/August issue of General Hospital Psychiatry.

Studies of depressed patients tend to focus on individuals who are seeing psychiatrists; this study is one of a few to focus on depressed patients seeking treatment in a primary care setting. Most patients with mental illnesses seek help from their primary care physicians, according to the study.

Brown and colleagues analyzed the treatment results from a group of 181 primary care patients who received eight months of treatment for moderate to severe depression.

Patients who perceived more self-control of their health experienced greater reduction in depression symptoms, whether they were treated with psychotherapy or the antidepressant nortriptyline, the researchers found.

Indeed, this greater sense of control of health was the most important factor associated with reduction in depressive symptoms in patients treated with interpersonal psychotherapy, the study results suggested.

"These findings are consistent with earlier reports suggesting that a person's expectations and beliefs are important in the successful treatment of depression, particularly with psychotherapy," said Brown.

The researchers also noted that patients suffering from a psychiatric disorder in addition to depression -- such as panic disorder or generalized anxiety disorder -- were less likely to recover from their depressive episode, whether they were treated with psychotherapy or nortriptyline.

"These findings highlight the need to adequately assess symptoms of anxiety disorder and a patient's beliefs in the controllability of depressive symptoms and functioning in order to treat depression effectively and to minimize the risk of relapse and recurrence," concludes Brown.
-end-
This study was supported by the National Institute of Mental Health and the American Foundation for Suicide Prevention.

General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Don R. Lipsitt, MD, at 617-499-5008.

Posted by the Center for the Advancement of Health <http://www.cfah.org>. For information about the Center, call Petrina Chong, <pchong@cfah.org> 202-387-2829.

Center for Advancing Health

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