Early intervention for depression helps

In a review of an article published in JAMA Psychiatry in early March 2016, Dr. Steven Dubovsky writes about encouraging findings about treatment efficacy of patients with major depression from a large study in Denmark.

In the study, researchers reviewed 10 years worth of national data from the extensive population records capped in Denmark which provides nearly universal access to psychiatric services in inpatient, outpatient, and emergency psychiatric settings.

The research looked at the records of 11,640 patients with a first diagnosis of adult-onset major depressive disorder (MDD) between 1995 and 2002. There appeared to be four major types of outcomes:

• Brief contact with psychiatric specialty care (77% of patients): The vast majority of patients received short-term psychiatric treatment with a very low likelihood of further psychiatric treatment (in this group only 1% per year had any psychiatric specialty care in the nine years after their initial treatment).

• Prolonged initial contact (13%): Some patients received intensive specialty psychiatric treatment for the first 2 years after diagnosis; but after that intensive treatment the probability of further specialty care was very low in the following eight years for this group (2 to 3% per year).

• Later reentry (7%): This group of patients had moderately high rates of psychiatric specialty treatment during the first 2 years after diagnosis; then, for a few years, the amount of care decreased; and then, during the last 5 years of follow-up, the amount treatment increased above the initial rate.

• Persistent contact (3%): A small group of patients had a continued high likelihood of specialty treatment throughout the first 6 years; and then the amount of psychiatric treatment dropped somewhat in the following 4 years.

Dr. Dubovsky writes that –

At least in Denmark, most acutely depressed patients seem to do well after initial treatment lasting up to 2 years, whereas patients with more-severe illness have more persistent, or at least intermittently ongoing, specialty care. We do not know which treatments were administered, but the current findings encourage us: If we treat depression vigorously, especially its initial episode, the long-term outcome will be good. More-severely ill patients should be treated even more vigorously to reduce relapse and recurrence. 

References

Musliner KL et al. Heterogeneity in 10-year course trajectories of moderate to severe major depressive disorder: A Danish National Register-based study. JAMA Psychiatry 2016 Mar 2; [e-pub]. (http://dx.doi.org/10.1001/jamapsychiatry.2015.3365)