Is remission of depressive symptoms in primary care a realistic goal? A meta-analysis

Marliese Y Dawson, Erin E Michalak, Paul Waraich, J Ellen Anderson, Raymond W Lam, Marliese Y Dawson, Erin E Michalak, Paul Waraich, J Ellen Anderson, Raymond W Lam

Abstract

Background: A primary goal of acute treatment for depression is clinical remission of symptoms. Most meta-analyses of remission rates involve randomized controlled trials (RCTs) using patients from psychiatric settings, but most depressed patients are treated in primary care. The goal of this study was to determine remission rates obtained in RCTs of treatment interventions for Major Depressive Disorder (MDD) conducted in primary care settings.

Methods: Potentially relevant studies were identified using computerized and manual search strategies up to May 2003. Criteria for inclusion included published RCTs with a clear definition of remission using established outcome measures.

Results: A total of 13 studies (N = 3202 patients) meeting inclusion criteria were identified. Overall remission rates for active interventions ranged between 50% and 67%, compared to 32% for pill placebo conditions and 35% for usual care conditions.

Conclusions: Remission rates in primary care studies of depression are at least as high as for those in psychiatric settings. It is a realistic goal for family physicians to target remission of symptoms as an optimal outcome for treatment of depression.

Figures

Figure 1
Figure 1
Remission rates for specific treatment conditions from randomized controlled trials (RCTs) of interventions for depression in primary care settings. The white lines represent the mean remission rates and the boxes represent the 95% confidence interval. N is the number of treatment arms in the RCTs (Note: Psychotx = Psychotherapy, Antidepr = Antidepressants, pts = patients).

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