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Assessing effectiveness of treatment of depression in primary care: Partially randomised preference trial

  • Navjot Bedi (a1), Clair Chilvers (a2), Richard Churchill (a3), Michael Dewey (a2), Conor Duggan (a4), Katherine Fielding (a2), Virginia Gretton (a2), Paul Miller (a2), Glynn Harrison (a1), Alan Lee (a1) and Idris Williams (a3)...

Extract

Background

There is a mismatch between the wish of a patient with depression to have counselling and the prescription of antidepressants by the doctor.

Aims

To determine whether counselling is as effective as antidepressants for depression in primary care and whether allowing patients to choose their treatment affects their response.

Method

A partially randomised preference trial, with patients randomised to either antidepressants or counselling or given their choice of either treatment. The treatment and follow-up were identical in the randomised and patient preference arms.

Results

There were 103 randomised and 220 preference patients in the trial. We found: no differences in the baseline characteristics of the randomised and preference groups; that the two treatments were equally effective at 8 weeks, both for the randomised group and when the randomised and patient preference groups for a particular treatment were combined; and that expressing a preference for either treatment conferred no additional benefit on outcome.

Conclusions

These data challenge several assumptions about the most appropriate treatment for depression in a primary care setting.

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Copyright

Corresponding author

Professor Conor Duggan, East Midlands Centre for Forensic Mental Health, Arnold Lodge, Cordelia Close, Leicester LE5 0LE, UK

Footnotes

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Declaration of interest

None. The NHS Executive, Trent, funded the study.

Footnotes

References

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Churchill, R., Dewey, M., Gretton, V., et al (1999) Should general practitioners refer patients with major depression to counsellors? A review of current published evidence. British Journal of General Practice, 49, 737743.
Churchill, R., Khaira, M., Gretton, V., et al (2000) Treating depression in general practice: factors affecting patients' treatment preferences. British Journal of General Practice, in press.
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Priest, R. G., Vize, C., Roberts, M., et al (1996) Lay peoples attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch. British Medical Journal, 313, 858859.
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Assessing effectiveness of treatment of depression in primary care: Partially randomised preference trial

  • Navjot Bedi (a1), Clair Chilvers (a2), Richard Churchill (a3), Michael Dewey (a2), Conor Duggan (a4), Katherine Fielding (a2), Virginia Gretton (a2), Paul Miller (a2), Glynn Harrison (a1), Alan Lee (a1) and Idris Williams (a3)...

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Assessing effectiveness of treatment of depression in primary care: Partially randomised preference trial

  • Navjot Bedi (a1), Clair Chilvers (a2), Richard Churchill (a3), Michael Dewey (a2), Conor Duggan (a4), Katherine Fielding (a2), Virginia Gretton (a2), Paul Miller (a2), Glynn Harrison (a1), Alan Lee (a1) and Idris Williams (a3)...
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