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Major Depression and Its Response to Sertraline in Primary Care vs. Psychiatric Office Practice Patients

Results of an Open-Label Trial in Argentina

Received November 25, 1997; revised March 4, 1998; accepted March 13, 1998. From the Neuropsychiatry and Memory Group of The Johns Hopkins University and Hospital and from the Neuropsychiatry Group (Siren) of the Centro de Enseanza Medica e Investigaciones Clinicas (CEMIC), Buenos Aires, Argentina. Address correspondence and reprint requests to Dr. Lyketsos, Osler 320, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287.

Great strides have been achieved in recent years in the detection and treatment of major depressive disorder (MDD) in primary care settings. Little is known about the types or patients with MDD seen in primary care as compared with those seen in psychiatric office practice. Few studies have compared clinical outcomes after treatment with antidepressants in these two settings. In Argentina, the authors conducted an open-label treatment study of MDD patients in primary care (n=469) and psychiatric office practice (n=299). The patients were compared on baseline sociodemographic and clinical variables. These same patients were treated with sertraline 50–100 mg per day for 8 weeks. At baseline, the patients in psychiatric office practice were younger, more likely to abuse alcohol, less likely to have comorbid medical disorders, and more likely to have failed a prior treatment for depression during the current episode. The two groups did not differ significantly on depression severity or in depressive symptom profile on the Hamilton Depression Rating Scale (Ham-D). After 8 weeks of treatment, mean Ham-D scores were reduced comparably in both groups, from about 25 to about 10. Rates of adverse events were 14%–29%, depending on the follow-up interval. Adherence with treatment was high in both groups (over 95%). The patients in primary care and psychiatry office practice are similar in several ways. Significant reductions in depressive symptoms are possible in both settings, in large numbers of patients, by using doses of sertraline in the 50–100 mg range.

Key Words: Depression • Sertraline • Primary Care

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