Defining 'Cure' From Depression: Do GPs and Psychiatrists Agree?

Megan Brooks

May 15, 2011

May 15, 2011 (Honolulu, Hawaii) — A survey of physicians suggests primary care physicians and psychiatrists have similar views on what criteria are important in defining "cure" from depression but differ in their overall attitudes about depression.

Reported here at the American Psychiatric Association 2011 Annual Meeting, results of the survey were reported by investigators from the Université Catholique de Louvain, Belgium.

Medscape Medical News asked coinvestigator Koen Demyttenaere, MD, PhD, of University Psychiatric Center KuLeuven, Leuven, Belgium, what prompted the survey.

"We believe that the way outcome is measured during treatment in depressed patients is too narrow and is not always reflecting the patient's expectations," said Dr. Demyttenaere.

Dr. Eric Constant

The standard outcome measures are often those suggested by regulatory bodies and focus mainly on "decrease in depressive symptomatology," while other aspects (like comorbid anxious symptoms, somatic symptoms, impairment in functioning, and also positive mood and quality of life) are "often overlooked, although the latter are documented to be very important in the patient's view," he said.

'Striking' Agreement on Good Outcome

In an Internet-based survey, the investigators asked 369 Belgian physicians (264 general practitioners and 105 psychiatrists) for their opinions on what outcomes they see as important in defining cure from depression and their attitudes about depression and its treatment.

According to the results, "there is a striking concordance in which aspects of life (symptoms, functioning, quality of life, etc) are important for considering a good outcome between primary care physicians and psychiatrists," Dr. Demyttenaere noted.

"Functioning, positive affect, and some quality-of-life items are considered as important by both groups of physicians as are depressive symptoms, [while] somatic symptoms are systematically considered as not important in defining a good outcome."

On the other hand, the survey revealed very different attitudes toward depression, depressed patients, and treatment options for depression between primary care physicians and psychiatrists.

"It is embarrassing," Dr. Demyttenaere said, "to see that a high percentage of primary care physicians consider the treatment of depressed patients as 'not rewarding' or 'heavy going' since most depressed patients should be treated in primary care."

The survey also hints that primary care physicians who believe more in psychotherapeutic approaches to depression tend to find the treatment of depression more rewarding, whereas psychiatrists who believe more in pharmacotherapy of depression tend to find the treatment of depression more rewarding.

Implications for Care

Psychiatrists were also more apt than general practitioners to report prescribing antidepressants to more than 50% of their patients (69% vs 37%). In logistic regression analysis, the attitude factors of general practitioners, but not psychiatrists, were significantly associated with rates of antidepressant prescribing (P = .02), the researchers say.

Dr. Demyttenaere noted that physicians who have a "more biological view on depression tend to agree more with the statement that the treatment goal is the same in all depressed patients, while physicians who have a more psychological view on depression do agree less with a common treatment goal for each depressed patient.

"These findings," the researcher told Medscape Medical News, "could help to improve clinical practice since they convincingly show that physicians' own personal attitudes and beliefs play an important role in how they treat depressed patients.

"It would be interesting to know whether our findings are country specific or not, and with some funding we could replicate this in a few countries," Dr. Demyttenaere added.

American Psychiatric Association (APA) 2011 Annual Meeting: Abstract NR04-10. Presented May 15, 2011.