According to projections from the World Health Organization, depression will be the second leading cause of disability in the developed world by 2020. Primary care clinicians care for approximately two thirds of depressed individuals. In 2000, the U.S. economic burden of depressive disorders was estimated to be 83.1 billion dollars. This included 31% direct medical costs, 7% suicide-related mortality costs, and 62% workplace costs. A variety of strategies have been tested to improve patient outcomes. Among these, integrated care models have emerged as both effective and cost effective. A recent systematic review identifies symptom monitoring as a key element of these integrated care models. However, the review did not identify the standardized depression scales that are responsive to clinically important change.
A separate but important issue raised by Veterans Administration (VA) Stakeholders is how long to continue antidepressant medication for patients who respond to acute phase treatment. Clinical guidelines recommend continuation treatment for 4-6 months for uncomplicated major depression and some national performance measures are linked to these guidelines. However, clinical guidelines for longer-term maintenance phase treatment are more variable and performance indicators (e.g., Healthcare Effectiveness Data and Information Set, HEDIS) do not address maintenance phase treatment. A better understanding of the evidence for long-term treatment efficacy with antidepressants would inform guidelines and performance measurement.