Treatment of dysthymia and minor depression in primary care: A ramdomized trial in patients aged 18 to 59 years

James E. Barrett, John W. Williams, Thomas E. Oxman, Ellen Frank, Wayne Katon, Mark Sullivan, Mark T. Hegel, John E. Cornell, Anjana S. Sengupta

Research output: Contribution to journalArticle

159 Scopus citations

Abstract

OBJECTIVE We evaluated the effectiveness of paroxetine and Problem-Solving Treatment for Primary Care (PST-PC) for patients with minor depression or dysthymia. STUDY DESIGN This was an 11-week randomized placebo-controlled trial conducted in primary care practices in 2 communities (Lebanon, NH, and Seattle, Wash). Paroxetine (n=80) or placebo (n=81) therapy was started at 10 mg per day and increased to a maximum 40 mg per day, or PST-PC was provided (n=80). There were 6 scheduled visits for all treatment conditions. POPULATION We included a total of 241 primary care patients with minor depression (n=114) or dysthymia (n=127). Of these, 191 patients (79.3%) completed all treatment visits. OUTCOMES We measured depressive symptoms using the 20-item Hopkins Depression Scale (HSCL-D-20). Remission was scored on the Hamilton Depression Rating Scale (HDRS) as less than or equal to 6 at 11 weeks. We measured functional status with the physical health component (PHC) and mental health component (MHC) of the 36-item Medical Outcomes Study Short Form. RESULTS All treatment conditions showed a significant decline in depressive symptoms over the 11-week period. There were no significant differences between the interventions or by diagnosis. For dysthymia the remission rate for paroxetine (80%) and PST-PC (57%) was significantly higher than for placebo (44%, P=.008). The remission rate was high for minor depression (64%) and similar for each treatment group. For the MHC there were significant outcome differences related to baseline level for paroxetine compared with placebo. For the PHC there were no significant differences between the treatment groups. CONCLUSIONS For dysthymia, paroxetine and PST-PC improved remission compared with placebo plus nonspecific clinical management. Results varied for the other outcomes measured. For minor depression, the 3 interventions were equally effective; general clinical management (watchful waiting) is an appropriate treatment option.

Original languageEnglish (US)
Pages (from-to)405-412
Number of pages8
JournalJournal of Family Practice
Volume50
Issue number5
Publication statusPublished - May 1 2001

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Keywords

  • Behavioral treatment [non-MESH] depression
  • Behavioral treatment paroxetine
  • Depressive disorder
  • Dysitymia [non-MESH]
  • Monor depression [non-MESH]
  • Paroxetine

ASJC Scopus subject areas

  • Family Practice

Cite this

Barrett, J. E., Williams, J. W., Oxman, T. E., Frank, E., Katon, W., Sullivan, M., ... Sengupta, A. S. (2001). Treatment of dysthymia and minor depression in primary care: A ramdomized trial in patients aged 18 to 59 years. Journal of Family Practice, 50(5), 405-412.