Abstract
Background
Depression is a leading cause of disease burden and most patients with depression are managed in primary care. Depression can be recurrent and chronic, and it is estimated that 50% of patients still meet criteria for depression despite taking an adequate dose of antidepressants for at least 6 consecutive weeks, so called treatment resistant depression (TRD). NICE guidance focuses on pharmacological and psychological interventions for depression. There is limited literature on the strategies patients with depression use to manage their symptoms. This qualitative study was nested in a placebo-controlled trial of mirtazapine added to SSRI or SNRI antidepressants for TRD (MIR).
Methods
46 primary care patients with depression were interviewed: a sample of MIR trial participants (‘completers’), and a sample of people who declined to participate (‘decliners’) in the trial. Interviews were digitally recorded with consent and transcribed. Data were analysed using a constant comparison approach.
Results
23 decliners and 23 completers were interviewed. Participants reported how trying to stay well is a hard, complex and often desperate task, describing a variety of strategies such as dietary supplements, the internet, support groups and yoga, to cope with the fear and unpredictability of their illness, driving them to try one approach after another. Once an effective strategy had been found, participants reported a reluctance to change, for fear of disturbing their hard-won equilibrium.
Discussion
In managing patients with depression, GPs need to explore the patient’s position on their illness trajectory and elicit the coping strategies already attempted, discarded and utilised.
Depression is a leading cause of disease burden and most patients with depression are managed in primary care. Depression can be recurrent and chronic, and it is estimated that 50% of patients still meet criteria for depression despite taking an adequate dose of antidepressants for at least 6 consecutive weeks, so called treatment resistant depression (TRD). NICE guidance focuses on pharmacological and psychological interventions for depression. There is limited literature on the strategies patients with depression use to manage their symptoms. This qualitative study was nested in a placebo-controlled trial of mirtazapine added to SSRI or SNRI antidepressants for TRD (MIR).
Methods
46 primary care patients with depression were interviewed: a sample of MIR trial participants (‘completers’), and a sample of people who declined to participate (‘decliners’) in the trial. Interviews were digitally recorded with consent and transcribed. Data were analysed using a constant comparison approach.
Results
23 decliners and 23 completers were interviewed. Participants reported how trying to stay well is a hard, complex and often desperate task, describing a variety of strategies such as dietary supplements, the internet, support groups and yoga, to cope with the fear and unpredictability of their illness, driving them to try one approach after another. Once an effective strategy had been found, participants reported a reluctance to change, for fear of disturbing their hard-won equilibrium.
Discussion
In managing patients with depression, GPs need to explore the patient’s position on their illness trajectory and elicit the coping strategies already attempted, discarded and utilised.
| Original language | English |
|---|---|
| Publication status | Published - 26 Mar 2015 |
| Event | National Primary Care Mental Health Research Conference - Durham University, Stockton on Tees, United Kingdom Duration: 26 Mar 2015 → … |
Conference
| Conference | National Primary Care Mental Health Research Conference |
|---|---|
| Country/Territory | United Kingdom |
| City | Stockton on Tees |
| Period | 26/03/15 → … |