The Treatment Options for Minor Depression In Primary Care: Systematic Review

Abstract

Background:Minor depression is more common than major depression in primary care. However, treatment guidelines are usually provided for the major depression. This study purpose is to systematically review the available evidence for treatment of minor depression in primary care. Method:The databases of PUBMED, CINAHL and Psychlnfo were searched to January 2007. The studies focused on patients suffering from minor depression were included. Two reviewers independently reviewed and extracted data independently. Results:Total 1038 patients with minor depression from 8 RCTs were identified and analyzed. Sample size of studies varied from 29 to 387 patients and follow up time varied from 6 weeks to 57 months. From the review, the treatment options for minor depression in primary care were grouped into three categories: pharmacologic treatment, psychotherapy and collaborative team care. The effect of pharmacologic treatment (amitriptyline and paroxetine) and psychotherapy (problem-solving therapy and cognitive behavioral therapy) are still controversy when compared with usual care. For the effects of collaborative team care between psychiatrists and primary care physicians, the studies showed no significant outcomes compared with usual care from primary care doctors. However, the long term effect of CBT and behavioral treatment showed the positive effect at 12 months and 57 months respectively. Conclusion:There are relatively few evidences for treatment minor depression in primary care. The review found three groups of treatment options: pharmacologic treatment, psychotherapy and collaborative team care. However, the effectiveness of these options is still inconclusive. The potential effectiveness from the treatment options of minor depression should be further investigated.