Abstract
Major depression is one of the most common medical disorders seen in primary care practice. Management frequently fails to meet recommended standards of treatment. For example, only a minority of patients are treated with antidepressants. The goals of this study were to establish the safety and effectiveness in the real world of a protocol-based pharmacological intervention administered by primary care physicians trained by psychiatrists. This was a naturalistic, open, 8-week, noncomparative, multicenter study of sertraline, 50-100 mg, in the treatment of 469 patients with mild-to-moderate major depression seen in primary care office settings. Effectiveness was assessed using the Hamilton Depression Rating Scale. The mean value of the HDRS declined steadily from 25.4 at baseline to 8.5 at day 56 (p < 0.0001). Fifty-two percent of patients achieved a full remission (HDRS <10 on day 56) and 70% had a positive response (50% reduction in HDRS scores). Only 26% had side effects, most of them mild. Major depression can be successfully diagnosed and treated by primary care physicians when adequately trained and supported by psychiatrists.