Depression in Primary care: Interpersonal Counseling vs Selective serotonin reuptake inhibitors. The DEPICS Study. A multicenter randomized controlled trial. Rationale and design

Abstract

BackgroundDepression is a frequently observed and disabling condition in primary care, mainly treated by Primary Care Physicians with antidepressant drugs. Psychological interventions are recommended as first-line treatment by the most authoritative international guidelines but few evidences are available on their efficacy and effectiveness for mild depression.Methods/DesignThis multi-center randomized controlled trial was conducted in 9 Italian centres with the aim to compare the efficacy of Inter-Personal Counseling, a brief structured psychological intervention, to that of Selective Serotonin Reuptake Inhibitors. Patients with depressive symptoms referred by Primary Care Physicians to psychiatric consultation-liaison services were eligible for the study if they met the DSM-IV criteria for major depression, had a score ≥13 on the 21-item Hamilton Depression Rating Scale, and were at their first or second depressive episode. The primary outcome was remission of depressive symptoms at 2-months, defined as a HDRS score ≤ 7. Secondary outcome measures were improvement in global functioning and recurrence of depressive symptoms at 12-months. Patients who did not respond to Inter-Personal Counseling or Selective Serotonin Reuptake Inhibitors at 2-months received augmentation with the other treatment.DiscussionThis trial addresses some of the shortcomings of existing trials targeting major depression in primary care by evaluating the comparative efficacy of a brief psychological intervention that could be easily disseminated, by including a sample of patients with mild/moderate depression and by using different outcome measures.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12608000479303

No Effect of Serotoninergic Gene Variants on Response to Interpersonal Counseling and Antidepressants in Major Depression

“…After a baseline assessment, eligible patients were partially randomized to a brief structured psychological intervention (IPC) or to antidepressant treatment (mainly SSRIs)(Table 1). 46 Patients were collected in three centers: 35 were collected at the Neuroscience Department, Turin University, 41 at the Department of Health Sciences, Section of Psychiatry, University of Pavia and 84 at the Department of Biomedical and NeuroMotor Sciences, Bologna University. All patients collected at the Institute of Psychiatry, Bologna University were treated with antidepressants and not randomized.…”

Is interpersonal counselling (IPC) sufficient treatment for depression in primary care patients? A pilot study comparing IPC and interpersonal psychotherapy (IPT)

“…The recommended number of therapy sessions was set at 6+1 following the structure of IPC as laid down by Judd et al (2004) and the protocol of Menchetti et al (2010Menchetti et al ( , 2014. It was recommended that the sessions should last 45 minutes (not the original 30 min.).…”

Interpersonal Counseling (IPC) for Depression in Primary Care

“…Menchetti et al (2010, 2013) conducted a multi-center randomized controlled trial in primary care centers in Italy, comparing the effectiveness of IPC to selective serotonin reuptake inhibitors (SSRIs). Patients with depressive symptoms were referred by primary care physicians.…”