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Published Online: 17 September 2018

Improving Depression Outcome by Patient-Centered Medical Management

Abstract

Specific challenges that profoundly affect the outcome of treatment for depression include 1) patient engagement and retention in care and optimization of treatment adherence, 2) optimization of symptom and side effect control by medication adjustments using measurement-based care procedures, 3) restoration of daily functioning and quality of life, and 4) prevention or at least mitigation of symptomatic relapse or recurrence. According to data from the Sequenced Treatment Alternatives to Relieve Depression study, some 10%–15% of patients will not return for treatment after an initial thorough evaluation visit; an additional 20%–35% will not complete the first acute-phase treatment step, and another 20%–50% will not complete 6 months of continuation treatment. Among patients who stay in treatment, over 50% exhibit poor adherence. Thus, most patients do not overcome the first two challenges. There are no systematic, widely agreed-upon psychosocial approaches to any of these four major challenges. The authors propose “patient-centered medical management” to address each of the four challenges, using psychoeducational, behavioral, cognitive, interpersonal, and dynamic models and methods. A renewed emphasis on the development and testing of systematic approaches to overcoming these common clinical challenges could enhance the chances of patient recovery and care system cost efficiencies.
[AJP AT 175: Remembering Our Past As We Envision Our Future
July 1933: Psychotherapeutics at Stockbridge
Horace K. Richardson: “Frequently, in the simpler situations, very few interviews are required in order that he [the patient] discover for himself what part of the adaptive machinery is at fault, and for him to develop a technique of handling the maladjustment on a more satisfactory level in the future.” (Am J Psychiatry 1933; 90:45–56)]

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 1187 - 1198
PubMed: 30220219

History

Received: 9 April 2018
Revision received: 30 May 2018
Revision received: 4 June 2018
Accepted: 11 June 2018
Published online: 17 September 2018
Published in print: December 01, 2018

Keywords

  1. Depression
  2. Psychotherapy
  3. Symptom Control
  4. Treatment Attrition
  5. Medical Management

Authors

Details

A. John Rush, M.D. [email protected]
From the Duke–National University of Singapore Graduate Medical School, Singapore; the Department of Psychiatry, Duke University Medical School, Durham, N.C.; the Department of Psychiatry, Texas Tech Health Sciences Center–Permian Basin, Midland-Odessa; the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia.
Michael E. Thase, M.D.
From the Duke–National University of Singapore Graduate Medical School, Singapore; the Department of Psychiatry, Duke University Medical School, Durham, N.C.; the Department of Psychiatry, Texas Tech Health Sciences Center–Permian Basin, Midland-Odessa; the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia.

Notes

Address correspondence to Dr. Rush ([email protected]).
Presented in part at the 17th World Congress of Psychiatry of the World Psychiatry Association, Berlin, October 8–12, 2017, and at Grand Rounds, Department of Psychiatry, New York University, February 2018.

Funding Information

Dr. Rush has served as a consultant for Akili, Brain Resource, Compass, Curbstone Consultant LLC, Emmes, Holmusk, Johnson & Johnson (Janssen), Liva-Nova, MindLinc, Sunovion, Taj Medical, and Takeda USA, speaking fees from Liva-Nova, and royalties from Guilford Press and the University of Texas Southwestern Medical Center (for use of the Inventory of Depressive Symptoms and its derivatives); he is named co-inventor on two U.S. patents (7,795,033 and 7,906,283, on methods to predict outcome and risk of side effects with antidepressant treatment). Dr. Thase has served as consultant or adviser for Acadia, Akili, Alkermes, Allergan (Forest, Naurex), AstraZeneca, Cerecor, Eli Lilly, Fabre-Kramer, Gerson Lehrman Group, Guidepoint Global, Janssen (Johnson & Johnson, Ortho-McNeil), Lundbeck, MedAvante, Merck, Moksha8, Nestlé (PamLab), Neuralstim, Neuronetics, NeuroRx, Novartis, Otsuka, Pfizer, Shire, Sunovion, and Takeda; he has received grant support from Acadia, the Agency for Healthcare Research and Quality, Alkermes, Allergan (Forest), AssureRx, Avanir, Axome, Forest Pharmaceuticals, Intracellular Pharmaceuticals, Janssen, Johnson & Johnson, NIMH, Otsuka, the Patient-Centered Outcomes Research Institute, and Takeda; he receives royalties from American Psychiatric Press, Guilford Publications, Herald House, and W.W. Norton; and his spouse is an employee of Peloton Advantage, which does business with Pfizer and AstraZeneca.

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