Effectiveness of watchful waiting versus antidepressants for patients diagnosed of mild to moderate depression in primary care: A 12-month pragmatic clinical trial (INFAP study).
Por:
Iglesias M, Aznar I, Peñarrubia-María MT, Gil MM, Fernández-Vergel R, Alonso J, Serrano-Blanco A and Rubio-Valera M
Publicada:
1 sep 2018
Ahead of Print:
26 jun 2018
Categoría:
Psychiatry and mental health
Resumen:
BACKGROUND: Although mild to moderate major depressive disorder (MDD) is one of the main reasons for consulting a general practitioner (GP), there is still no international consensus on the most appropriate therapeutic approach. METHODS: The aim of this study is to evaluate the clinical effectiveness of watchful waiting (WW) compared with the use of antidepressants (ADs) for the treatment of mild to moderate depressive symptoms in 263 primary care (PC) usual-practice patients in a 12-month pragmatic non-randomised controlled trial. Both longitudinal and per-protocol analyses were performed, through a multilevel longitudinal analysis and a sensitivity analysis. RESULTS: We observed a statistically significant time x treatment interaction in the severity of depression (Patient Health Questionnaire, PHQ-9) and disability (World Health Organization Disability Assessment Schedule, WHODAS) in favour of the AD group at 6 months but not at 12 months. The effect size of this difference was small. No statistically significant differences were observed between groups in severity of anxiety (Beck Anxiety Inventory, BAI) or health-related quality-of-life (EuroQol-5D, EQ-5D). Sensitivity analysis and per-protocol analysis showed no differences between the two groups in any of the evaluated scales. CONCLUSIONS: Superiority of either treatment (WW and AD) was not demonstrated in patients treated for depression in PC after one year of follow-up.
Filiaciones:
Iglesias M:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
School of Medicine, University of Barcelona, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
Aznar I:
Teaching, Research Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
Peñarrubia-María MT:
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut (ICS), Catalonia, Spain
Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
Gil MM:
Teaching, Research Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
School of Pharmacy and Food Sciences, Universitat de Barcelona, Barcelona, Spain
Fernández-Vergel R:
SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut (ICS), Catalonia, Spain
Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
Alonso J:
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
Pompeu Fabra University (UPF), Barcelona, Spain
Serrano-Blanco A:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
Teaching, Research Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
Rubio-Valera M:
Teaching, Research Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
School of Pharmacy and Food Sciences, Universitat de Barcelona, Barcelona, Spain
Open Access
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