Objective: remission of depression in primary care The Oreon Study

Treatment of depression should result in the absence of symptoms, i.e. remission, in order to restore the functional status of the patient and reduce the risk for relapse. The study assessed the current remission rates in primary care and determined the influencing factors.

10 consecutive depressive patients treated by antidepressants for at least 3 months and not more than 12 months were screened by each investigator. Remission rates were defined using the Hamilton-Depression scale 7 items (score of 3 or less) as well as the Carroll self rating scale (score of 7 or less). In addition, patients completed the Sheehan Disability Scale (SDS). Initial severity of depression, type of treatment and socio-economic factors were collected.

292 general practitioners screened a total of 2630 patients. Results indicated low remission rates: 28.3% according to the clinician and 17.1% according to the patient. Absence of remission was associated with higher impairment in work, social and family life. The most frequently reported residual symptoms in nonremitters were general somatic symptoms (92%), depressed mood (92%), psychic anxiety (91%) and impaired work and activities (89%). No differences were observed in remission rates between men and women. Remission rates were significantly lower in patients living alone as compared to those living in couple or family (25.1% vs 30.2%, p=0.03), in patients with lower education (21.3% vs 32.3%, p<0.001), in patients speaking French as compared to Dutch (24.0% vs 34.0% p<0.001), and unemployed patients compared to patients having an occupation (17.1% vs 39.0%, p<0.001). Higher initial severity and number of previous episodes decreased remission rates (p<0.001).

This study shows low remission rates in depressed patients treated in general practice. The absence of remission is associated with impairment in work, social and family life. Special attention should be given to identify patients who do not reach remission.