Improving Depression Outcome by Patient-Centered Medical Management.

Improving Depression Outcome by Patient-Centered Medical Management.
Am J Psychiatry. 2018 Sep 17;:appiajp201818040398
Authors: Rush AJ, Thase ME
Abstract
Specific challenges that profoundly affect the outcome of treatment for depression include 1) patient engagement and retention in care and optimization of treatment adherence, 2) optimization of symptom and side effect control by medication adjustments using measurement-based care procedures, 3) restoration of daily functioning and quality of life, and 4) prevention or at least mitigation of symptomatic relapse or recurrence. According to data from the Sequenced Treatment Alternatives to Relieve Depression study, some 10%-15% of patients will not return for treatment after an initial thorough evaluation visit; an additional 20%-35% will not complete the first acute-phase treatment step, and another 20%-50% will not complete 6 months of continuation treatment. Among patients who stay in treatment, over 50% exhibit poor adherence. Thus, most patients do not overcome the first two challenges. There are no systematic, widely agreed-upon psychosocial approaches to any of these four major challenges. The authors propose "patient-centered medical management" to address each of the four challenges, using psychoeducational, behavioral, cognitive, interpersonal, and dynamic models and methods. A renewed emphasis on the development and testing of systematic approaches to overcoming these comm...

Source: The American Journal of Psychiatry - September 17, 2018 Category: Psychiatry Authors: Rush AJ, Thase ME Tags: Am J Psychiatry Source Type: research