Cited by 76Psychotherapy Techniques and ApplicationsTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Improving Depression Outcome by Patient-Centered Medical Management

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Rush, A. John, Thase, Michael E.·2018·American Journal of Psychiatry

Abstract

Specific challenges that profoundly affect the outcome of treatment for depression include 1) patient engagement and retention in care and optimization of treatment adherence, 2) optimization of symptom and side effect control by medication adjustments using measurement-based care procedures, 3) restoration of daily functioning and quality of life, and 4) prevention or at least mitigation of symptomatic relapse or recurrence. According to data from the Sequenced Treatment Alternatives to Relieve Depression study, some 10%-15% of patients will not return for treatment after an initial thorough evaluation visit; an additional 20%-35% will not complete the first acute-phase treatment step, and another 20%-50% will not complete 6 months of continuation treatment. Among patients who stay in treatment, over 50% exhibit poor adherence. Thus, most patients do not overcome the first two challenges. There are no systematic, widely agreed-upon psychosocial approaches to any of these four major challenges. The authors propose "patient-centered medical management" to address each of the four challenges, using psychoeducational, behavioral, cognitive, interpersonal, and dynamic models and methods. A renewed emphasis on the development and testing of systematic approaches to overcoming these common clinical challenges could enhance the chances of patient recovery and care system cost efficiencies. [AJP AT 175: Remembering Our Past As We Envision Our Future July 1933: Psychotherapeutics at Stockbridge Horace K. Richardson: "Frequently, in the simpler situations, very few interviews are required in order that he [the patient] discover for himself what part of the adaptive machinery is at fault, and for him to develop a technique of handling the maladjustment on a more satisfactory level in the future." (Am J Psychiatry 1933; 90:45-56 )].

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  • Inaccuracy of the MDD diagnosis is a common reason for pseudo-resistance.

    “Inaccuracy of the MDD diagnosis is a com­ mon reason for pseudo-­ resistance.”

    From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [154]

    The Adherence section identifies poor adherence as a contributor to pharmacotherapy failure, and the Relapse Mitigation section discusses obtaining a reliable illness history. Neither passage says that an inaccurate MDD diagnosis is a common reason for pseudo-resistance; searches for pseudo-resistance, misdiagnosis, and diagnostic accuracy found no passage addressing that claim. The indexed passages provide no page number. (LLM, conf=0.72)

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Research works printed but not linked: 5

  1. [5]5. American Psychiatric Association: Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 3rd edition. Washington, DC, American Psychiatric Association, 2010 (https:// psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/ guidelines/mdd.pdf )
  2. [11]11. Fawcett J, Epstein P, Fiester SJ, et al: Clinical management: imipramine/placebo administration manual. Psychopharmacol Bull 1987; 23:309-324
  3. [14]14. Sansone RA, Sansone LA: Antidepressant adherence: are patients taking their medications? Innov Clin Neurosci 2012; 9:41-46
  4. [98]98. Liu ZQ, Zeng X, Duan CY: Neuropsychological rehabilitation and psychotherapy of adult traumatic brain injury patients with de- pression: a systematic review and meta-analysis. J Neurosurg Sci 2018; 62:24-35 100.
  5. [99]99. Muñoz San José A, Oreja-Guevara C, Cebolla Lorenzo S, et al: Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: the contribution of mindfulness-based interventions. Neurologia 2016; 31:113-120 101.

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Authors
Rush, A. J., & Thase, M. E.
Affiliations
National University of Singapore (SG)
Venue
American Journal of Psychiatry
Published
2018-12-01
Volume
175
Issue
12
Pages
1187-1198
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
OpenAlex
W2891761611
Cited by
76
References
106
Citations by year
2026: 9 · 2025: 13 · 2024: 10 · 2023: 9 · 2022: 11 · 2021: 6 · 2020: 13 · 2019: 3 · 2018: 2
FWCI
1.02
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Eli Lilly and Company
  • Pfizer
  • AstraZeneca
  • Patient-Centered Outcomes Research Institute
  • University of Texas Southwestern Medical Center
  • Sunovion
  • Cerecor
  • H. Lundbeck A/S
  • Agency for Healthcare Research and Quality
  • Allergan
  • National Institute of Mental Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depression, medication adherence, patient engagement, treatment retention, relapse prevention, adverse drug reactions, measurement-based care, psychoeducation, cognitive behavioral therapy, interpersonal psychotherapy, quality of life, daily functioning, cost efficiency
MeSH terms
Antidepressive Agents, Depression, Humans, Treatment Outcome, Patient-Centered Care, Medication Adherence

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