Motivational Interviews for Depression in Primary Care
Major Depression
About this trial
This is an interventional health services research trial for Major Depression
Eligibility Criteria
Inclusion Criteria:
- Women and men aged 18 or older presenting at one of the seven DHH study clinics with a new treatment episode for depression will be considered for the study.
- The PHQ-9 is used to define depression category with a sensitivity and specificity for MDD of at least 88%. Patients must have PHQ-9≥10 to ensure sufficient severity to warrant intervention.
- A new treatment episode is defined as no treatment with an antidepressant medication for emotional problems over the previous 90 days, nor evidence-based psychotherapy for depression.
- The subjects must have major depression as determined by diagnostic schedule.
Exclusion Criteria:
- Receipt of an antidepressant medication in the previous 90 days other than a low-dose TCA for pain or Trazodone for sleep (e.g. amitriptyline ≤ 50 mg a day or Trazodone ≤ 100 mg at night).
- Current interpersonal or cognitive behavioral psychotherapy that focuses on depression.
- Female subjects who are either pregnant or nursing.
- Subjects with drug or alcohol dependency or abuse (except for nicotine or caffeine) within the preceding 6 months.
- High risk for suicide.
- Inability to communicate in English.
- No personal telephone or homeless.
- Lifetime bipolar disorder.
- Psychosis.
- Subjects with a lifetime history of autism, mental retardation, or pervasive developmental disorders.
- Subjects with uncorrected hypothyroidism or hyperthyroidism.
- Serious, unstable illnesses including hepatic, renal, gastroenterologic, respiratory, cardiovascular (including ischemic heart disease), endocrinologic, neurologic, immunologic, or hematologic disease.
Sites / Locations
- Denver Health and Hospital Authority
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Guideline-based Medical Management
Motivational Interview with GBMM
Manual-based GBMM training will be provided to both intervention and control physicians. A note on the patient's chart will apprise the primary care provider that the patient screened positive for moderate or more severe depressive symptoms, and has agreed to participate in the study. The evidence-based algorithm covers medical management of depression including indications for treatment, selection of initial therapy, starting dosages, dose escalation, switching or augmenting treatment, assessing efficacy, treatment goals and duration, a schedule of follow-up visits and referral indications
Motivational Interviewing for Depression combined with guideline-based medical management for depression