Adherence to guidelines and effectiveness of inpatient treatment for unipolar depression

This naturalistic study is a contribution to randomized controlled trials which reflect only a very limited part of patients of the clinical practice and the relevance of guideline recommended treatment.

Adhering to quality assurance and development of treatment guidelines, 224 patients were evaluated for the effectiveness of inpatient treatment of unipolar depressive disorders by assessing admission and discharge depression scores, response and remission rates. Furthermore patients who were treated according to current guidelines (duration of treatment, dosage of antidepressants, combination of medication and psychotherapy) were compared to patients who did not meet those criteria. Primary outcome measure was the 17-item Hamilton Rating Scale for Depression (HAMD). Secondary outcome measures included Beck Depression Inventary (BDI).

Mean HAMD-17 total score decreased from 28.9 to 8.0. Effect sizes d were similar to other naturalistic studies (d(HAMD) = 2.9; d(BDI) = 1.4); 84.4% of the patients could reach complete or partial response criteria for the HAMD-17. Patients treated according to guidelines could reach remission in 73% of cases (HAMD) vs. 59.6% remission rate for non-guideline patients.

This trial shows high remission rates in inpatient treatment of depression compared to similar effectiveness studies. Guideline according treatment might be superior to other treatment strategies.