Intended for healthcare professionals

Primary Care

Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care

BMJ 2002; 325 doi: (Published 26 October 2002) Cite this as: BMJ 2002;325:934
  1. Kathryn Rost,, professor (Kathryn.Rost{at},
  2. Paul Nutting, director of researchb,
  3. Jeffrey L Smith, project directora,
  4. Carl E Elliott, statistical analysta,
  5. Miriam Dickinson,, biostatisticiana
  1. aCenter for Studies in Family Medicine, Department of Family Medicine, University of Colorado Health Sciences Center, UCHSC at Fitzsimons, PO Box 6508 Mail Stop F496, Aurora, CO 80045-0508, USA
  2. b Center for Research Strategies, 225 East 16th Avenue, Suite 1150, Denver, CO 80203, USA
  1. Correspondence to: Kathryn Rost
  • Accepted 22 April 2002


Objectives: To evaluate the long term effect of ongoing intervention to improve treatment of depression in primary care.

Design: Randomised controlled trial.

Setting: Twelve primary care practices across the United States.

Participants: 211 adults beginning a new treatment episode for major depression; 94% of patients assigned to ongoing intervention participated.

Intervention: Practices assigned to ongoing intervention encouraged participating patients to engage in active treatment, using practice nurses to provide care management over 24 months.

Main outcome measures: Patients' report of remission and functioning.

Results: Ongoing intervention significantly improved both symptoms and functioning at 24 months, increasing remission by 33 percentage points (95% confidence interval 7% to 46%), improving emotional functioning by 24 points (11 to 38) and physical functioning by 17 points (6 to 28). By 24 months, 74% of patients in enhanced care reported remission, with emotional functioning exceeding 90% of population norms and physical functioning approaching 75% of population norms.

Conclusions: Ongoing intervention increased remission rates and improved indicators of emotional and physical functioning. Studies are needed to compare the cost effectiveness of ongoing depression management with other chronic disease treatment routinely undertaken by primary care.


  • Funding This study was supported by the National Institute of Mental Health grants MH54444 and MH63651, with extra funding by the John D and Catherine T MacArthur Foundation.

  • Competing interests KR has been reimbursed by Forest Laboratories, manufacturer of Celexa, for attending a symposium.

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