1. Amongst patients with moderate to severe depression being initiated on pharmacotherapy, using the shared decision-making tool, Depression Medication Choice, made patients and physicians feel greater comfort and empowerment compared to usual care.
2. However, the Depression Medication Choice had no significant effect on patient adherence or depression outcomes at the end of the 6-month follow-up period.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Depression is a very debilitating condition affecting a significant portion of the American population. The mainstay of treatment for moderate to severe depression is pharmacotherapy. However, not enough data exist on comparative effectiveness of these medications. More predictable, however, are some of the adverse effects. Both of these lead to difficulty with initiating and maintaining patients on appropriate therapy. This study was designed to determine whether a decision aid, Depression Medication Choice, could improve patient and physician experience, medication adherence, and outcomes. The results of the study showed that both the physicians and patients in the decision aid arm of the study felt more comfortable and empowered compared to the usual care group. However, the Depression Medication Choice had no significant effect on patient adherence or depression outcomes at the end of the six-month follow-up period.
The strength of the study was mainly in the design, applying the Depression Medication Choice in a randomized fashion. However, there was no blinding, so there is a significant risk of bias. Also, the results may not be generalizable since only a narrow geographic population was enrolled. Additionally, a 6-month follow-up period may not have been long enough for clinical outcomes differences to manifest.
In-Depth [randomized controlled trial]: Ten primary care practices in Minnesota and Wisconsin were randomized to either Depression Medication Choice (DMC) or usual care (UC) – five in each group. The study took place from 2011 to 2013. The primary outcomes evaluated at six months were subjective quality of decision-making process from the patients’ and physicians’ perspective, patient adherence, and clinical outcomes (as determined by the PHQ-9).
At the end of the six months, the patients in the decision aid arm felt more comfortable with decision (p = 0.01) and felt more knowledgeable (p = 0.03). Similarly, the physicians in the decision aid arm felt more comfortable (p < 0.001) and were more satisfied (p = 0.02). However, there was no significant difference in the rate of adherence or differences in PHQ-9 scores at the six-month mark.
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