The severity of major depression and choice of treatment in primary care practice

The Agency for Health Care Policy and Research Depression Guideline Panel recommended pharmacotherapy as the Ist-line treatment for more severely depressed primary care patients, but research supporting its recommendation has not been conducted with this population. A post hoc analysis was conducted, therefore, with data gathered in a randomized controlled trial about the relationship between initial level of depressive severity and functional ability, treatment with nortriptyline hydrochloride (NT) or interpersonal psychotherapy (IPT), and clinical course over 8 months among primary care patients experiencing major depression. Treatment type was unrelated to clinical course among more severely depressed patients (baseline 17-item Hamilton Rating Scale for Depression [HRSD] score greater than or equal to 20). However, less severely depressed patients (baseline 17-item HRSD score less than or equal to 19) who were prescribed NT improved significantly more rapidly during the initial 3 months of treatment than patients provided with IPT.