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Most primary care patients with depression prefer counseling over medication

Despite effective psychotherapy and antidepressant medication, about three-fourths of primary care patients with depression do not receive appropriate care. Yet a new study reveals that most (83 percent) of these patients, regardless of the severity of their symptoms, want to be treated for their depression, and most prefer counseling over medication. However, specific treatment preferences vary by race, sex, income, and knowledge about treatments, according to the research. The study was supported in part by the Agency for Healthcare Research and Quality (HS08349).

Kenneth B. Wells, M.D., M.P.H., of the University of California, Los Angeles, and his colleagues based their findings on answers to questionnaires and telephone interviews with nearly 1,200 depressed patients at 46 primary care clinics in 7 geographic regions of the country. The majority who preferred treatment were nearly 4 times as likely to be wealthier (odds ratio, OR 3.7) and almost 3 times as likely to be more knowledgeable about antidepressant medication (OR 2.6) than those who did not want to be treated for their depression. Low-income patients may be less likely to prefer active treatment because of competing priorities for time and money or the belief among the poor that treatments for depression are ineffective, suggest the researchers.

Among those patients who desired treatment, 67 percent preferred counseling over medication as the first line of treatment. Blacks were twice as likely as whites (OR 2.2) and those more knowledgeable about counseling were twice as likely as those who weren't (OR 2.1) to choose counseling.

Nearly half (47 percent) of patients who wanted counseling for their depression preferred group over individual counseling. Medication and therapy have roughly equal efficacy, especially for those with mild to moderate depressive disorders. However, they differ in terms of time spent and costs, degree of self-disclosure and interaction with others, and use of psychoactive medications. The researchers recommend asking patients about their treatment preferences to better ensure compliance and satisfaction. They also discuss the need to increase access to counseling from primary care.

See "Treatment preferences among depressed primary care patients," by Megan Dwight-Johnson, M.D., M.P.H., Cathy D. Sherbourne, Ph.D., Diana Liao, M.P.H., and Dr. Wells, in the August 2000 Journal of General Internal Medicine 15, pp. 527-534.

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