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Tijdschrift voor Psychiatrie 49 (2007) 8, 559 - 567

Review article

How can the results of primary-care treatment for depression be improved?

A.C.M. Vergouwen, H. Burger, T.J.M. Verheij, G.F. Koerselman

summary
background The results of treatment for depression are frequently disappointing. The main reasons for this are inadequate treatment and non-compliance.
aim This article attempts to deal with the question of how patient compliance and the results of treatment for depression can be improved.
method We performed a critical analysis of the literature. We searched Medline (1966- January 2002), psycinfo (1984-January 2002), Embase (1980-January 20002) and the Cochrane Controlled Trials Register (1966-Janaury 2002) for reports of randomised controlled trials. In our search we used the terms 'patient compliance', 'adherence', patient dropout', 'depression', 'depressive disorder', and 'affective disorder'. On the basis of the results of our search we compared two interventions that could be applied in Dutch practices.
results We found 11 articles, all relating to treatment in primary care settings. Usual care proved to be inadequate. The quality of the usual care currently provided can be improved by extra interventions. So far there are no indications that complex interventions benefit the patient more than simple interventions, such as regular follow-up procedures. Therefore, for the time being, simple interventions are to be preferred.
conclusion Treatment for depression can be improved by means of relatively simple interventions.

keywords major depressive disorder, patient compliance, primary health care, therapy