What do psychiatrists talk about with their depressed patients parallel to prescribing an antidepressant?

Abstract

Background. Treatment of depression includes pharmacotherapy as well as psychotherapy. Even if no specific psychotherapy is done, still, pharmacotherapy must be accompanied by patient education, reassurance and guidance. There is a lack of data available on the content of psychiatrist–patient interactions additional to prescribing an antidepressant. Method. A total of 43 psychiatrists in ambulatory practice treated 200 depressed outpatients for 12 weeks with the antidepressant mirtazapine. Content of the patient–psychiatrist interaction was assessed by the pivotal topic method. Results. Patient–psychiatrist encounters lasted on average 17.5 min (SD = 6.9 min). Primary topics were at the beginning of treatment the therapeutic alliance, assessment of symptoms, patient education, and discussion of problems in life; after 2 weeks of medication compliance; after 8 weeks progress of illness and increase of activities; and after 12 weeks progress and relapse prevention. Limitations. Only patients who were treated with an antidepressant were included, so that results may be different in other cases. Conclusion. The primary content of conversation is case management, supportive reassurance and alliance building while specific pychotherapeutic interventions are the exception. The content of psychiatrist–patient verbal interaction depends on time of treatment. The data describe “psychiatric counselling and psychotherapy” in routine care as opposed to “specific psychotherapy”.

Key Words::

• Treatment of depressive disorder
• counselling
• psychotherapeutic intervention
• psychiatrists
• guidelines

Acknowledgements

None.

Statement of Interest

The data in this article were taken from a drug utilization observation study on mirtazapine that was done by Organon, Germany. Neither the company representatives nor any other party participated in data analysis and writing of the manuscript, nor did they approve or disapprove what has been written.