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Management of treatment-resistant depression in primary care: a mixed-methods study

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)e673-e681
Number of pages9
JournalBritish Journal of General Practice
Issue number675
Early online date24 Sep 2018
DateAccepted/In press - 23 May 2018
DateE-pub ahead of print - 24 Sep 2018
DatePublished (current) - 1 Oct 2018


Background: Non-response to antidepressant medication is common in primary care. Little is known about how GPs manage patients with depression that does not respond to medication.

Aim: To describe usual care for primary care patients with treatment resistant depression (TRD).

Design and Setting: Mixed methods study using data from a UK primary care multi-centre randomised controlled trial.

Method: 235 patients with TRD randomised to continue with usual GP care were followed up at three-month intervals for a year. Self-report data were collected on antidepressant medication, number of GP visits and other treatments received. In addition, 14 semi-structured face-to-face interviews were conducted with a purposive sample after the 6 month follow-up and analysed thematically.

Results: Most patients continued on the same dose of a single antidepressant between baseline and 3 months (n=147/186 at 3 months, 79% (95%CI: 73%, 85%)). Figures were similar for later follow-ups (e.g. 9-12 months: 72% (95%CI: 63%, 79%). Medication changes (increasing dose; switching to a different antidepressant; adding a second antidepressant) were uncommon. Participants described usual care mainly as taking antidepressants, with consultations focused on other (physical) health concerns. Few accessed other treatments or were referred to secondary care.

Conclusion: Usual care in patients with TRD mainly entailed taking antidepressants and medication changes were uncommon. The high prevalence of physical and psychological co-morbidity means that when these patients consult, their depression may not be discussed. Strategies are needed to ensure the active management of this large group of patients whose depression does not respond to antidepressant medication.

    Research areas

  • depression, antidepressants, management, treatment resistance, primary care, mixed methods

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