Psychiatric News December 17, 2004
Volume 39 Number 24
© 2004 American Psychiatric Association
p. 2
Treating Depression as Chronic Brings Positive Results
Mark Moran
Major depression is the largest single cause of nonfatal disease burden
in Australia, responsible for 6.2 percent and 9.8 percent of years lived with
disability in men and women, respectively.
Optimal treatment of depression using cognitive-behavioral therapy and
antidepressant medication as part of a long-term strategy that views the
disorder as a chronic, rather than an episodic, illness could significantly
diminish the overall disease burden of depression.
This finding is from a novel study of avertable disease burden of major
depression in Australia reported in the November Archives of General
Psychiatry. The researchers used secondary analysis of mental health
survey data in Australia, statistical models of the natural history of
depression, and meta-analyses of data on effectiveness of therapy to estimate
the burden of disease that might be averted using optimal,
guideline-recommended practices.
"Our results strongly support longerterm treatment strategies for
depression," said lead author Gavin Andrews, M.D., and colleagues.
"The main reasons for this favorable outcome are that maintenance
treatment prevents relapses and that relapses that do occur are being treated
from the start.
"Similarities in community survey findings on the epidemiology of
major depression in the United States and Australia and the predominantly
United States studies on the impact of treatments used in our model make it
likely that our results also have relevance to depression in the United
States."
Andrews is with the clinical research unit for anxiety and depression at
the University of New South Wales in Sydney.
Andrews and colleagues estimated that current episodic treatment patterns
avert 9 percent of the burden experienced by those in contact with health
services. But optimal treatment of an episode with cognitive-behavioral
therapy could avert 28 percent of the disease burden, and 24 percent with
medications, they said.
During the five years after an episode of major depression, current
episodic treatment patterns would avert 13 percent of "disability
adjusted life years (DALY)," an indicator of the time lived with a
disability and the time lost due to premature mortality, whereas maintenance
drug treatment could avert 50 percent, and maintenance CBT could avert 52
percent.
"Because the vast majority of people with depression experience
multiple episodes over a lifetime and are particularly prone to relapses
shortly after an index episode, there are convincing arguments for treating
all depression as a chronic disorder and not just those with recurrent or more
severe episodes as recommended in current treatment guidelines," the
researchers said.
Darrel Regier, M.D., M.P.H., explained that the study is an unusually
sophisticated approach that draws on a "burden of disease" model
used by the World Health Organization in calculating the global burden of
psychiatric illness.
In that model, the component of the DALY relating to duration of time lost
due to premature mortality is calculated with model life tables using standard
expected years of life lost; the reduction in physical capacity due to
morbidity is measured using disability weights.
The DALY is then combined with prevalence data and—in Andrews'
study—with information on effectiveness of current and optimal
treatments to yield estimates of avertable burden of disease.
Regier, who is executive director of the American Psychiatric Institute for
Research and Education and director of APA's Division of Research, noted that
Andrews has published similar papers on schizophrenia and anxiety disorders
and spoke last year to the APA Assembly about his research.
"This is an enormously complex set of measurements that he has
brought to bear on the subject in an extremely creative way," Regier
said. "It is a wonderfully comprehensive approach to looking at the true
public health challenge of improving mental health in a population."
Major depression is the largest single cause of nonfatal disease burden in
Australia, responsible for 6.2 percent and 9.8 percent of years lived with
disability in men and women, respectively. In 2000 an estimated 555 male and
198 female deaths by suicide were attributable to major depression in
Australia.
The study, "The Burden of Major Depression Avoidable by
Longer-Term Treatment Strategies," is posted online at
<http://archpsyc.ama-assn.org/cgi/content/full/61/11/1097?>.
Arch Gen Psychiatry 2004 61 1097[Abstract/Free Full Text]
Get information about faster international access.
Privacy Policy
Copyright © 2004
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
| 
