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The Journal of the American Board of Family Practice 16:22-31 (2003)
© 2003 American Board of Family Practice

Patient Beliefs Predict Response to Paroxetine Among Primary Care Patients with Dysthymia and Minor Depression

Mark D. Sullivan, MD, PhD, Wayne J. Katon, MD, Joan E. Russo, PhD, Ellen Frank, PhD, James E. Barrett, MD, Thomas E. Oxman, MD and John W. Williams, Jr, MD

Department of Psychiatry (MDS, WJK, JER), University of Washington, Seattle
Western Psychiatric Institute (EF), University of Pittsburgh, Dartmouth Medical School, Hanover, NH
Department of Community and Family Health (JEB), Dartmouth Medical School, Hanover, NH
Department of Psychiatry (TEO), Dartmouth Medical School, Hanover, NH
Center for Health Services Research in Primary Care (JWW), HSR&D, Department of Veterans Affairs Medical Center and Duke University Medical Center, Durham, NC

Correspondence: Address reprint requests to Mark D. Sullivan, MD, PhD, Psychiatry and Behavioral Sciences, Box 356560, University of Washington, Seattle, WA 98195

Background: Dysthymia and minor depression are common problems in primary care, but it is not known how patient health beliefs shape response to antidepressant treatment of these less severe forms of depression.

Methods: Three hundred thirty-three primary care patients with dysthymia or minor depression received at least 4 weeks of paroxetine or placebo in a multicenter, randomized controlled 11-week trial. Patient health beliefs and other characteristics were examined as predictors of treatment adherence and depression remission.

Results: Patient beliefs were not predictive of adherence to paroxetine or placebo. Patients with less endorsement of biological beliefs about their condition (odds ratio [OR] = 3.40), higher perceived general health (OR = 3.38), meeting criteria for dysthymia (OR = 2.37), and age younger than 60 years (OR = 2.68) were more likely to achieve remission on paroxetine. Patient beliefs did not predict remission on placebo. Those with lower severity of depression symptoms at baseline (OR = 2.70) and women (OR = 2.18) were most likely to achieve remission on placebo.

Conclusions: Our results suggest that patients with dysthymia or minor depression are more likely to respond to antidepressant medication if they do not see their depression as a biological illness and see themselves as generally healthy. It is clearly not necessary for patients to believe that their dysthymia or minor depression is biological to respond to antidepressant medication.




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Am J Psychiatry, September 1, 2005; 162(9): 1588 - 1601.
[Abstract] [Full Text] [PDF]


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