‘Real-life burden of depression’ surveys – GP and patient perspectives on treatment and management of recurrent depression

Abstract

Depression is a chronic, recurrent illness carrying a heavy burden for the health service and the community. Current evidence suggests that the majority of patients with depression will experience recurrent episodes of illness, although there is extensive evidence that continuation therapy with antidepressant drugs will prevent relapse. Two surveys were designed and distributed in the UK in 2002 to compare the expectations of patients and GPs in the management of relapse in depression. For the patient survey, 1010 completed questionnaires of the 7000 distributed (through the charity Depression Alliance), were returned for analysis and feedback. For the GP survey (endorsed by the charity Primary care Mental Health Education (PriMHE), 200 responses were received from the 400 GPs contacted. A majority of patients in the survey (85%) who experience depression expressed concern about recurrent episodes and 88% of respondents had suffered at least one repeat episode. The survey found that 65% of respondents had stopped taking their medication at some stage: reasons cited include unacceptable side-effects and lack of efficacy. The findings suggest that discontinuation and non-compliance of therapies is associated with recurrent depression. Continuation therapy is now standard treatment to avoid recurrent depression; however, the majority of GPs questioned, continued therapy for less than the 6 months after acute treatment response as advised by the British Associated of Psychopharmacologists. Although depression is generally managed well at primary care level, this survey highlights the major worries of depression sufferers concerning further episodes of depression and the need to prevent relapse and recurrence through safe and effective therapies with which these patients are happy to comply.

Managing depression in primary care: A meta-synthesis of qualitative and quantitative research from the UK to identify barriers and facilitators

“…These were used most often [43,45]. GPs commonly considered this their only option due to a lack of availability of psychological therapy or other specialist services [31,32].…”

“…GPs commonly considered this their only option due to a lack of availability of psychological therapy or other specialist services [31,32]. However, despite beliefs that antidepressants are effective,[35,39] it was found that prescribing guidelines were not always followed and prescriptions were for too low a dose and for too short a time [40,44,45]. Prescribing may be influenced by perceptions of patients' attitudes to antidepressants,[34,40] although GPs reported strategies to overcome negative beliefs [34].…”

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

“…Seven qualitative [37][38][39][40][41][42][43] and 10 quantitative studies of the management of primary depression were included. [44][45][46][47][48][49][50][51][52][53] Figure 1 shows the flow of studies through the review process.…”

“…. educational interventions directed at GPs will not improve patient outcome 42 Lack of training and knowledge 39,46,50,51,53 education efforts should focus on increasing GPs' sense of therapeutic optimism and providing them with sufficient skill in and knowledge of a range of psychological procedures 52 GPs would benefit from educational programmes that promote awareness of current treatment guidelines 47 Many PNs and some GPs say they need more training in managing depression, but this is not a priority for them. Training should be grounded in professionals' understandings of depression and should seek to improve attitudes to working with depressed people Not all information was available for each study.…”

“…GP goals and management approach 37 GPs' accounts of diagnosing and caring for patients with depression 40 GPs experience of the diagnosis and management of depression 43 Importance of listening 37 Time as a barrier to listening 42 Time and consultation length, disclosure, antidepressants, time management 41 Management of late-life depression in primary care 39 Antidepressant use 44,[47][48][49]52 Role of specialist services 50 Managing depression 46 Clinicians used antidepressants, talking therapies, listening and specialist services. Listening to depressed patients takes time; this may be a barrier to effective treatment, but one in-depth study contested this…”