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	Institution: CLOCKSS  | My Account | E-mail Alerts | Access Rights | Sign In Vol. 4 No. 2, February 1995   Archives  •  Online Features Original Contributions  This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal Applicability of Clinical Pharmacotherapy Guidelines for Major Depression in Primary Care Settings Herbert C. Schulberg, PhD; Marian R. Block, MD; Michael J. Madonia; Eric Rodriguez, MD; C. Paul Scott, MD; Judith Lave, PhD Arch Fam Med. 1995;4(2):106-112. Abstract Objective To determine whether guidelines established for pharmacologic treatment of major depression are feasible in primary care. Design Prospective cohort study. Setting Ambulatory family health centers and internal medicine clinics. Patients Ninety-one primary care patients meeting criteria within the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition for a current major depression randomized to receive antidepressant medication after being judged by a psychiatrist as clinically eligible for pharmacotherapy in an ambulatory setting. Intervention Nortriptyline hydrochloride prescribed by primary care physicians trained in clinical guidelines specifying dosage schedules, durations, and procedures resembling those recommended by the AHCPR (Agency for Health Care Policy and Research) Depression Guideline Panel. Main Outcome Measures Patient participation and continuation in medication treatment. Results Fifty-five percent of patients completed the acute phase of treatment after a mean of 6.9 visits extending over a mean of 8.1 weeks. Of those patients entering the continuation phase, 60% completed the follow-up visits for 6 months. Taken together, only 33% of patients assigned to receive antidepressant medication completed the full regimen recommended by the AHCPR guidelines. Conclusions The treatment of depressed primary care patients within AHCPR guidelines for antidepressant medication is feasible but complex. Although primary care physicians ably adhere to these guidelines, keeping patients in treatment is difficult and possibly requires greater flexibility in treatment regimens. Author Affiliations From the University of Pittsburgh (Pa) School of Medicine (Drs Schulberg, Block, Rodriguez, Scott, and Lave, and Mr Madonia), The Western Pennsylvania Hospital (Dr Block), and St Margaret Memorial Hospital Family Practice Residency (Dr Scott), Pittsburgh. THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Physician alerts to increase antidepressant adherence: fax or fiction? Bambauer et al. Arch Intern Med 2006;166:498-504. ABSTRACT | FULL TEXT   Use of a Computerized Guideline for Glucose Regulation in the Intensive Care Unit Improved Both Guideline Adherence and Glucose Regulation Rood et al. J. Am. Med. Inform. Assoc. 2005;12:172-180. ABSTRACT | FULL TEXT   Randomized Trial of a Depression Management Program in High Utilizers of Medical Care Katzelnick et al. Arch Fam Med 2000;9:345-351. ABSTRACT | FULL TEXT   Somatoform Symptoms and Treatment Nonadherence in Depressed Family Medicine Outpatients Keeley et al. Arch Fam Med 2000;9:46-54. ABSTRACT | FULL TEXT   Treating Major Depression in Primary Care Practice: An Update of the Agency for Health Care Policy and Research Practice Guidelines Schulberg et al. Arch Gen Psychiatry 1998;55:1121-1127. ABSTRACT | FULL TEXT   Relapse of Depression in Primary Care: Rate and Clinical Predictors Lin et al. Arch Fam Med 1998;7:443-449. ABSTRACT | FULL TEXT   Managing Our Depressed Patients: Gold Standards vs Higher Standards Block Arch Fam Med 1998;7:462-464. FULL TEXT   The 'Usual Care' of Major Depression in Primary Care Practice Schulberg et al. Arch Fam Med 1997;6:334-339. ABSTRACT   Treating Depressed Primary Care Patients Improves Their Physical, Mental, and Social Functioning Coulehan et al. Arch Intern Med 1997;157:1113-1120. ABSTRACT   Treating Major Depression in Primary Care Practice: Eight-Month Clinical Outcomes Schulberg et al. Arch Gen Psychiatry 1996;53:913-919. ABSTRACT   The Role of Psychotherapy in the Treatment of Depression: Review of Two Practice Guidelines Rush Arch Gen Psychiatry 1996;53:298-300. ABSTRACT   The Blues: Now and Forever More? Bowman Arch Fam Med 1995;4:95-96. ABSTRACT   HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | HELP CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP   © 1995 American Medical Association. All Rights Reserved.