Depression Remission More Likely in Psychiatric Care Than in Primary Care

TORONTO—A Belgian observational study found significantly higher rates of remission when patients with depression were treated by a psychiatrist compared with a primary care physician.

The study was part of the OREON (Objective: Remission in Depression) project, and results were presented at the American Psychiatric Association’s 2006 annual meeting.

The results showed a 53.7% remission rate among 1087 patients with depression who were treated by primary care physicians and a 40.9% remission rate among 160 patients treated by psychiatrists. Both groups were treated for an average of 4.3 months.

This statistically significant difference may be because many more patients under psychiatric care receive a formal diagnosis rather than simply presenting with symptoms suggestive of depression, and they also have more severe and more frequently recurring episodes than patients treated in a primary care setting.

“A history of multiple depressive episodes and a higher severity at baseline decrease the chance of remission,” confirmed lead investigator Koen Demyttenaere, MD, of the Department of Psychiatry, Catholic University of Leuven, Belgium.

In addition, in primary care, remission was more likely in younger patients, those with more education, and those who were employed. Factors affecting remission in psychiatric care were similar, but men were more likely than women to reach remission.

Comorbid somatic complaints and anxiety disorders were associated with a lower likelihood of remission in all patients, regardless of treatment setting; alcohol abuse was not.

Finally, and perhaps surprisingly, in the overall study population, the addition of a benzodiazepine to monotherapy with either a selective serotonin reuptake inhibitor or a serotonin-norepinephrine reuptake inhibitor slightly reduced the chances of remission.