My previous post, "Treat The Depression, Extend Life", discussed how treating depression could reduce the risk of dying in patients with diabetes. I was curious about what constituted "depression care management". What was the specific treatment? The intervention which sought to decrease depressive symptoms was spelled out in the 2004 JAMA study below, also known as PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial):
Reducing Suicidal Ideation And Depressive Symptoms In Depressed Older Primary Care Patients
The treatment guidelines consisted of:
- Formal screening using established depression scales.
- ".. a first-line trial of a selective serotonin reuptake inhibitor (SSRI). The protocol specified citalopram because it is equally efficacious with other antidepressants, has limited drug interactions, low potential for central nervous system activation, and an insignificant withdrawal syndrome."
- "When a patient declined medication therapy, the physician could recommend interpersonal psychotherapy."
- "The depression care manager interacted with patients in person or by telephone at scheduled intervals, or when clinically necessary, to monitor depressive symptoms, medication adverse effects, and treatment adherence."
So, to achieve the benefits seen in both this study (which found that symptoms of depression and suicidal ideation could be decreased), and the previously posted study (which found that diabetes patients' lives could be extended), an intervention involving formal depression screening in the primary care setting, deployment of medication and/or psychotherapy, and regular follow-up - both scheduled and as-needed - by trained clinicians would have to be implemented.
It's also important to note that:
"Research funds covered the cost of interpersonal psychotherapy and citalopram."So, cost and insurance coverage are also considerations.
