This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (190)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Depression  • Psychotherapy  • Alert me on articles by topic

An Update of the Agency for Health Care Policy and Research Practice Guidelines

Herbert C. Schulberg, PhD; Wayne Katon, MD; Gregory E. Simon, MD; A. John Rush, MD

Arch Gen Psychiatry. 1998;55:1121-1127.

The Depression Guideline Panel of the Agency for Health Care Policy and Research in 1993 published recommendations for treating major depression in primary care practice that were often based on studies of tertiary care psychiatric patients. We reviewed reports of randomized controlled trials in primary care settings published between 1992 and 1998. This evidence indicates that both antidepressant pharmacotherapy and time-limited depression-targeted psychotherapies are efficacious when transferred from psychiatric to primary care settings. In most cases, the choice between these treatments should depend on patient preference. Studies to date suggest that improving treatment of depression in primary care requires properly organized treatment programs, regular patient follow-up, monitoring of treatment adherence, and a prominent role for the mental health specialist as educator, consultant, and clinician for the more severely ill. Future research should focus on how guidelines are best implemented in routine practice, since conventional dissemination strategies have little impact.

From the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pa (Dr Schulberg); Department of Psychiatry and Behavioral Sciences, University of Washington Medical School (Drs Katon and Simon), and Center for Health Studies, Group Health Cooperative (Dr Simon), Seattle, Wash; and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Dr Rush).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

An Official American Thoracic Society Clinical Policy Statement: Palliative Care for Patients with Respiratory Diseases and Critical Illnesses
Lanken et al.
Am. J. Respir. Crit. Care Med. 2008;177:912-927.
FULL TEXT  

Best Practices: Integrating Behavioral Health and Primary Care: The Harris County Community Behavioral Health Program
Begley et al.
Psychiatr. Serv. 2008;59:356-358.
ABSTRACT | FULL TEXT  

Late-Life Depression
Unutzer
NEJM 2007;357:2269-2276.
FULL TEXT  

Outcomes of a quality improvement project integrating mental health into primary care
Watts et al.
Qual Saf Health Care 2007;16:378-381.
ABSTRACT | FULL TEXT  

The Effect of Adherence to Practice Guidelines on Depression Outcomes
Hepner et al.
ANN INTERN MED 2007;147:320-329.
ABSTRACT | FULL TEXT  

Antidepressant use in multiple sclerosis: epidemiologic study of a large community sample
Cetin et al.
Mult Scler 2007;13:1046-1053.
ABSTRACT  

Costs of an Intervention for Primary Care Patients With Medically Unexplained Symptoms: A Randomized Controlled Trial
Luo et al.
Psychiatr. Serv. 2007;58:1079-1086.
ABSTRACT | FULL TEXT  

Depression and cardiovascular disease: healing the broken-hearted.
Whooley
JAMA 2006;295:2874-2881.
ABSTRACT | FULL TEXT  

A Framework to Improve the Quality of Treatment for Depression in Primary Care
Croghan et al.
Psychiatr. Serv. 2006;57:623-630.
ABSTRACT | FULL TEXT  

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence
Edlund and Harris
Psychiatr. Serv. 2006;57:692-699.
ABSTRACT | FULL TEXT  

Depression Treatment Preferences in Older Primary Care Patients
Gum et al.
Gerontologist 2006;46:14-22.
ABSTRACT | FULL TEXT  

Transforming Mental Health Care at the Interface With General Medicine: Report for the Presidents Commission
Unutzer et al.
Psychiatr. Serv. 2006;57:37-47.
ABSTRACT | FULL TEXT  

Design and Rationale for a Randomized, Controlled Trial of Interpersonal Psychotherapy and Citalopram for Depression in Coronary Artery Disease (CREATE)
Frasure-Smith et al.
Psychosom. Med. 2006;68:87-93.
ABSTRACT | FULL TEXT  

Economic Grand Rounds: Improving the Quality of Depression Care in Medicaid
Barry and Thomas
Psychiatr. Serv. 2005;56:1193-1195.
FULL TEXT  

Pediatric Behavioral Health in Primary Care: A Collaborative Approach
Campo et al.
J Am Psychiatr Nurses Assoc 2005;11:276-282.
ABSTRACT  

Depression Treatment in Primary Care
Robinson et al.
J Am Board Fam Med 2005;18:79-86.
ABSTRACT | FULL TEXT  

Disparities in the Adequacy of Depression Treatment in the United States
Harman et al.
Psychiatr. Serv. 2004;55:1379-1385.
ABSTRACT | FULL TEXT  

Trends in service use and treatment for mental disorders in adults throughout Great Britain
Brugha et al.
Br. J. Psychiatry 2004;185:378-384.
ABSTRACT | FULL TEXT  

Treatment Outcome and Physician-Patient Communication in Primary Care Patients With Chronic, Recurrent Depression
Schwenk et al.
Am. J. Psychiatry 2004;161:1892-1901.
ABSTRACT | FULL TEXT  

Teaching Residents and Program Directors About Physician Impairment
Broquet and Rockey
Acad. Psychiatry 2004;28:221-225.
ABSTRACT | FULL TEXT  

The role of GPs in treating psychological distress: a study of midlife Australian women
Outram et al.
Fam Pract 2004;21:276-281.
ABSTRACT | FULL TEXT  

Quality of Care for Medicaid-Covered Youth Treated With Antidepressant Therapy
Richardson et al.
Arch Gen Psychiatry 2004;61:475-480.
ABSTRACT | FULL TEXT  

Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients: A Randomized Controlled Trial
Bruce et al.
JAMA 2004;291:1081-1091.
ABSTRACT | FULL TEXT  

Psychosomatic Medicine: A New Psychiatric Subspecialty
Gitlin et al.
Acad. Psychiatry 2004;28:4-11.
ABSTRACT | FULL TEXT  

Review: complex organisational and educational interventions appear to be effective for managing depression in primary care
Primack and Pincus
Evid. Based Med. 2003;8:191-191.
FULL TEXT  

Evaluation of the Adequacy of Outpatient Antidepressant Treatment
Weilburg et al.
Psychiatr. Serv. 2003;54:1233-1239.
ABSTRACT | FULL TEXT  

Psychopharmacology Plus Psychotherapy for Depression Treatment
Unutzer et al.
Psychiatr. Serv. 2003;54:1042-1043.
FULL TEXT  

Implementing Evidence-Based Practices for People with Severe Mental Illness
Mueser et al.
Behav Modif 2003;27:387-411.
ABSTRACT  

Cost-Effectiveness of Collaborative Care for Depression in a Primary Care Veteran Population
Liu et al.
Psychiatr. Serv. 2003;54:698-704.
ABSTRACT | FULL TEXT  

When Should a Trial of Fluoxetine for Major Depression Be Declared Failed?
Quitkin et al.
Am. J. Psychiatry 2003;160:734-740.
ABSTRACT | FULL TEXT  

Use of Psychotropic Medications Among HIV-Infected Patients in the United States
Vitiello et al.
Am. J. Psychiatry 2003;160:547-554.
ABSTRACT | FULL TEXT  

Strategies for implementing evidence-based practices in routine mental health settings
Drake et al.
Evid. Based Ment. Health 2003;6:6-7.
FULL TEXT  

The evidence base for cognitive-behavioural therapy in depression: delivery in busy clinical settings
Whitfield and Williams
Adv. Psychiatr. Treat. 2003;9:21-30.
ABSTRACT | FULL TEXT  

A Three-Component Model for Reengineering Systems for the Treatment of Depression in Primary Care
Oxman et al.
Psychosomatics 2002;43:441-450.
ABSTRACT | FULL TEXT  

New Federal Initiatives To Enhance the Medical Treatment of Opioid Dependence
Fiellin and O'Connor
ANN INTERN MED 2002;137:688-692.
ABSTRACT | FULL TEXT  

Problem Substance Use Among Depressed Patients in Managed Primary Care
Roeloffs et al.
Psychosomatics 2002;43:405-412.
ABSTRACT | FULL TEXT  

Discontinuation of Use and Switching of Antidepressants: Influence of Patient-Physician Communication
Bull et al.
JAMA 2002;288:1403-1409.
ABSTRACT | FULL TEXT  

Multiple sclerosis, depression, and the risk of suicide
Caine and Schwid
Neurology 2002;59:662-663.
FULL TEXT  

A Review of Interventions to Reduce the Prevalence of Parasuicide
Comtois
Psychiatr. Serv. 2002;53:1138-1144.
ABSTRACT | FULL TEXT  

A Prospective Study of the Role of Depression in the Development and Persistence of Adolescent Obesity
Goodman and Whitaker
Pediatrics 2002;110:497-504.
ABSTRACT | FULL TEXT  

The Natural History of Late-Life Depression: A 6-Year Prospective Study in the Community
Beekman et al.
Arch Gen Psychiatry 2002;59:605-611.
ABSTRACT | FULL TEXT  

Two-Year Effects of Quality Improvement Programs on Medication Management for Depression
Unutzer et al.
Arch Gen Psychiatry 2001;58:935-942.
ABSTRACT | FULL TEXT  

The Electronic Medical Record: A Randomized Trial of Its Impact on Primary Care Physicians' Initial Management of Major Depression
Rollman et al.
Arch Intern Med 2001;161:189-197.
ABSTRACT | FULL TEXT  

Implementing Evidence-Based Practices for Persons With Severe Mental Illnesses
Torrey et al.
Psychiatr. Serv. 2001;52:45-50.
ABSTRACT | FULL TEXT  

Social Support and Treatment Response in Older Depressed Primary Care Patients
Oxman and Hull
J. Gerontol. B Psychol. Sci. Soc. Sci. 2001;56:35P-45.
ABSTRACT | FULL TEXT  

The Quality of Care for Depressive and Anxiety Disorders in the United States
Young et al.
Arch Gen Psychiatry 2001;58:55-61.
ABSTRACT | FULL TEXT  

Managing Depression in Medical Outpatients
Whooley and Simon
NEJM 2000;343:1942-1950.
FULL TEXT  

Quality of web based information on treatment of depression: cross sectional survey
Griffiths and Christensen
BMJ 2000;321:1511-1515.
ABSTRACT | FULL TEXT  

Efficacy of Nurse Telehealth Care and Peer Support in Augmenting Treatment of Depression in Primary Care
Hunkeler et al.
Arch Fam Med 2000;9:700-708.
ABSTRACT | FULL TEXT  

Improvement of Outcomes in Chronic Illness
Katon
Arch Fam Med 2000;9:709-711.
FULL TEXT  

Following Depression in Primary Care: Do Family Practice Physicians Ask About Depression at Different Rates Than Internal Medicine Physicians?
Nichols and Brown
Arch Fam Med 2000;9:478-482.
ABSTRACT | FULL TEXT  

Primary Care Role in the Management of Childhood Depression: A Comparison of Pediatricians and Family Physicians
Rushton et al.
Pediatrics 2000;105:957-962.
ABSTRACT | FULL TEXT  

Other articles noted
Evid. Based Ment. Health 1999;2:40-40.
FULL TEXT