Antidepressant treatment in the primary care office: outcomes for adjustment disorder versus major depression

Antidepressants are widely used by primary care physicians. Very little comparative data exists regarding the newer antidepressants in regards to efficacy in naturalistic primary care outpatient settings where the treatment of adjustment disorder and major depressive disorder is concerned. Our objective was to determine if there is a difference in antidepressant effectiveness between disorders in the newer antidepressants (SSRIs) in a primary care setting when a formal systematic depression treatment protocol is used.

A retrospective review of 63 major depression patients and 33 adjustment disorder patients in a primary care setting was undertaken. Patients had been prescribed mostly SSRIs. DSM-IV symptoms, PHQ-9 depression rating scale scores, and functional disability reports were systematically used to evaluate partial and full remission from patients' depressive states.

Neither depressed patients, nor adjustment disordered patients demonstrated a difference in clinical response to any particular antidepressant. The main statistical difference was in response rates, where patients diagnosed with adjustment disorder were twice as likely to respond to standard antidepressant treatment as depressed patients. This retrospective database design with moderate sample size limits the statistical power of this study.

Antidepressants are very effective in treating depression in the primary care setting and may even be an effective and efficient treatment for adjustment disorder with depressed mood.