Depression: Tylee A

Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, Matthews K, McAllister-Williams RH, Peveler RC, Scott J, Tylee A. · Senior Lecturer and Honorary Consultant Psychiatrist, Neuroscience and Psychiatry Unit, University of Manchester, UK. · J Psychopharmacol. · Pubmed #18413657 No free full text.

Abstract: A revision of the 2000 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.

Tylee A, Walters P. · No affiliation provided · Br J Gen Pract. · Pubmed #17504582 links to  free full text

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Tylee A, Walters P. · No affiliation provided · BMJ. · Pubmed #17478791 No free full text.

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Tylee A, Jones R. · No affiliation provided · BMJ. · Pubmed #15817529 links to  free full text

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Tylee A, Walters P. · No affiliation provided · Hosp Med. · Pubmed #12422488 No free full text.

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Tylee A. · No affiliation provided · Practitioner. · Pubmed #10715853 No free full text.

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Tylee A, Walters P. · Section of Primary Care Mental Health, Health Services Research Department, Institute of Psychiatry, Kings College, London, United Kingdom. · J Clin Psychiatry. · Pubmed #17288504 No free full text.

Abstract: Despite current debate on the methodology of existing research into depression and anxiety disorders, there is still general agreement that recognition rates of these conditions in primary care could be improved. This review examines the factors that influence recognition of these disorders from both the patients' perspective and the primary care givers' perspective. Approaches and methods for improving recognition in primary care, including guidelines, mental health skills training, screening, and increasing public awareness, are considered in detail.

Tylee A. · Institute of Psychiatry, King's College London, UK. · J Clin Psychiatry. · Pubmed #16848677 No free full text.

Abstract: The Depression Guideline Panel for the National Institute for Clinical Excellence (NICE) in England has developed a stepped-care model for the recognition and treatment of depression in primary care. The first 3 steps of the model apply to primary care settings and were developed to help primary care professionals overcome barriers to recognizing depression. The somatic symptoms of depression present the most significant barrier to recognition because patients who somatize their symptoms will often lead their physician to think there is a physical reason for the symptoms. This preoccupation with physical illness often delays or prevents diagnosis. Step 1 of the care model focuses on recognizing depression by initially assessing patient mood and interest. Step 2 suggests nonpharmacologic therapies for patients who have mild depression, and step 3 suggests pharmacologic and nonpharmacologic therapies for patients who have moderate-to-severe depression. Improving awareness of the symptoms of depression and physician core skills through guideline-driven practice will hopefully increase the recognition rates for depression in England.

Walters P, Tylee A. · Section of Primary Care Mental Health, Health Services Research Department, Institute of Psychiatry, De Crespigny Park, London. · Practitioner. · Pubmed #12879565 No free full text.

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Churchill R, Hunot V, Corney R, Knapp M, McGuire H, Tylee A, Wessely S. · Institute of Psychiatry, King's College London, UK. · Health Technol Assess. · Pubmed #12387733 links to  free full text

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Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Goldberg D, Magruder KM, Schulberg HC, Tylee A, Wittchen HU. · Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston 29425-0742, USA. · J Clin Psychiatry. · Pubmed #10326875 No free full text.

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Tylee A. · RCGP Unit for Mental Health Education in Primary Care, Section of Epidemiology and General Practice, Institute of Psychiatry, London, United Kingdom. · J Clin Psychiatry. · Pubmed #10326870 No free full text.

Abstract: Depression and anxiety are the most common mental disorders seen by primary care physicians. The conditions often coexist. It has been reported that about half the psychiatric comorbidity in patients visiting their primary care physician goes unrecognized. Consequently, there is widespread agreement that an improvement in recognition of mental illnesses is required. This review examines how patient characteristics and patient presentation affect the acknowledgment of depression. Furthermore, the role of the physician will be discussed, with relation to the importance of acquiring specific consulting and prescribing skills for dealing with patients with depression. It is hoped that, with increasing awareness of depression and the development of training schemes for primary care physicians that focus specifically on the recognition and management of the condition in this setting, underrecognition and undertreatment of the disorder will improve.

Perahia DG, Kajdasz DK, Walker DJ, Raskin J, Tylee A. · Lilly Research Centre, Erl Wood, Windlesham, Surrey, UK. · Int J Clin Pract. · Pubmed #16700869 links to  free full text

Abstract: There is ongoing debate regarding the effectiveness of antidepressants in patients with milder major depressive disorder (MDD). This post-hoc analysis evaluated the efficacy and tolerability of duloxetine in the subset of 159 (75 duloxetine and 84 placebo) patients with milder MDD (baseline HAMD17 total score > or = 15 and < or = 18) who were treated once daily with duloxetine 60 mg or placebo in two identical, 9-week, randomised, double-blind trials. At endpoint, change from baseline on HAMD17 was greater in the duloxetine group (-7.0) than in the placebo group (-4.1) (p = 0.005). Response and remission rates, and improvement on the Clinical Global Impressions-Severity (CGI-S) scale, the Patient Global Impressions-Improvement (PGI-I) scale, and measures of painful symptoms were also significantly better in the duloxetine group (p < 0.05). Tolerability was consistent with that seen in previous studies of duloxetine in patients with more severe depression. In conclusion, duloxetine 60 mg/day is effective and well tolerated in milder MDD.

McCrone P, Knapp M, Proudfoot J, Ryden C, Cavanagh K, Shapiro DA, Ilson S, Gray JA, Goldberg D, Mann A, Marks I, Everitt B, Tylee A. · Centre for the Economics of Mental Health, Institute of Psychiatry, King's College London, UK. · Br J Psychiatry. · Pubmed #15231556 links to  free full text

Abstract: BACKGROUND: Cognitive-behavioural therapy (CBT) is effective for treating anxiety and depression in primary care, but there is a shortage of therapists. Computer-delivered treatment may be a viable alternative. AIMS: To assess the cost-effectiveness of computer-delivered CBT. METHOD: A sample of people with depression or anxiety were randomised to usual care (n=128) or computer-delivered CBT (n=146). Costs were available for 123 and 138 participants, respectively. Costs and depression scores were combined using the net benefit approach. RESULTS: Service costs were 40 British pounds (90% CI - 28 British pounds to 148 British pounds) higher over 8 months for computer-delivered CBT. Lost-employment costs were 407 British pounds (90% CI 196 British pounds to 586 British pounds) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at 40 British pounds, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year. CONCLUSIONS: Computer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.

Proudfoot J, Ryden C, Everitt B, Shapiro DA, Goldberg D, Mann A, Tylee A, Marks I, Gray JA. · Centre for General Practice Integration Studies, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. · Br J Psychiatry. · Pubmed #15231555 links to  free full text

Abstract: BACKGROUND: Preliminary results have demonstrated the clinical efficacy of computerised cognitive-behavioural therapy (CBT) in the treatment of anxiety and depression in primary care. AIMS: To determine, in an expanded sample, the dependence of the efficacy of this therapy upon clinical and demographic variables. METHOD: A sample of 274 patients with anxiety and/or depression were randomly allocated to receive, with or without medication, computerised CBT or treatment as usual, with follow-up assessment at 6 months. RESULTS: The computerised therapy improved depression, negative attributional style, work and social adjustment, without interaction with drug treatment, duration of preexisting illness or severity of existing illness. For anxiety and positive attributional style, treatment interacted with severity such that computerised therapy did better than usual treatment for more disturbed patients. Computerised therapy also led to greater satisfaction with treatment. CONCLUSIONS: Computer-delivered CBT is a widely applicable treatment for anxiety and/or depression in general practice.

Kendrick T, Chatwin J, Dowrick C, Tylee A, Morriss R, Peveler R, Leese M, McCrone P, Harris T, Moore M, Byng R, Brown G, Barthel S, Mander H, Ring A, Kelly V, Wallace V, Gabbay M, Craig T, Mann A. · Primary Medical Care, Aldermoor Health Centre, University of Southampton, UK. · Health Technol Assess. · Pubmed #19401066 links to  free full text

Abstract: OBJECTIVES: To determine (1) the effectiveness and cost-effectiveness of selective serotonin reuptake inhibitor (SSRI) treatment plus supportive care, versus supportive care alone, for mild to moderate depression in patients with somatic symptoms in primary care; and (2) the impact of the initial severity of depression on effectiveness and relative costs. To investigate the impact of demographic and social variables. DESIGN: The study was a parallel group, open-label, pragmatic randomised controlled trial. SETTING: The study took place in a UK primary care setting. Patients were referred by 177 GPs from 115 practices around three academic centres. PARTICIPANTS: Patients diagnosed with new episodes of depression and potentially in need of treatment. In total, 602 patients were referred to the study team, of whom 220 were randomised. INTERVENTIONS: GPs were asked to provide supportive care to all participants in follow-up consultations 2, 4, 8 and 12 weeks after the baseline assessment, to prescribe an SSRI of their choice to patients in the SSRI plus supportive care arm and to continue treatment for at least 4 months after recovery. They could switch antidepressants during treatment if necessary. They were asked to refrain from prescribing an antidepressant to those in the supportive care alone arm during the first 12 weeks but could prescribe to these patients if treatment became necessary. MAIN OUTCOME MEASURES: The primary outcome measure was Hamilton Depression Rating Scale (HDRS) score at 12-week follow-up. Secondary outcome measures were scores on HDRS at 26-week follow-up, Beck Depression Inventory, Medical Outcomes Study Short Form-36 (SF-36), Medical Interview Satisfaction Scale (MISS), modified Client Service Receipt Inventory and medical record data. RESULTS: SSRIs were received by 87% of patients in the SSRI plus supportive care arm and 20% in the supportive care alone arm. Longitudinal analyses demonstrated statistically significant differences in favour of the SSRI plus supportive care arm in terms of lower HDRS scores and higher scores on the SF-36 and MISS. Significant mean differences in HDRS score adjusted for baseline were found at both follow-up points when analysed separately but were relatively small. The numbers needed to treat for remission (to HDRS > 8) were 6 [95% confidence interval (CI) 4 to 26)] at 12 weeks and 6 (95% CI 3 to 31) at 26 weeks, and for significant improvement (HDRS reduction > or = 50%) were 7 (95% CI 4 to 83) and 5 (95% CI 3 to 13) respectively. Incremental cost-effectiveness ratios and cost-effectiveness planes suggested that adding an SSRI to supportive care was probably cost-effective. The cost-effectiveness acceptability curve for utility suggested that adding an SSRI to supportive care was cost-effective at the values of 20,000 pounds-30,000 pounds per quality-adjusted life-year. A poorer outcome on the HDRS was significantly related to greater severity at baseline, a higher physical symptom score and being unemployed. CONCLUSIONS: Treatment with an SSRI plus supportive care is more effective than supportive care alone for patients with mild to moderate depression, at least for those with symptoms persisting for 8 weeks and an HRDS score of > or = 12. The additional benefit is relatively small, and may be at least in part a placebo effect, but is probably cost-effective at the level used by the National Institute for Health and Clinical Excellence to make judgements about recommending treatments within the National Health Service. However, further research is required.

Tylee A. · Section of Primary Care Mental Health, HSPR, Institute of Psychiatry, Kings College London, London, UK. · Evid Based Ment Health. · Pubmed #19395623 No free full text.

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Cronin E, Campbell S, Ashworth M, Hann M, Blashki G, Murray J, Tylee A. · Health Services Research Department, Institute of Psychiatry, King's College London, Section of Primary Care Mental Health, David Goldberg Building, De Crespigny Park, London SE5 8AF, UK. · Fam Pract. · Pubmed #19264839 No free full text.

Abstract: BACKGROUND: Depression represents a major and growing disease burden. About 90% of depressed patients are treated solely in primary care, yet there are system-related barriers to primary care for people with depression in the UK and Australia, countries which have different health care arrangements. OBJECTIVES: The aim was to explore the views of GPs and patients in London and Melbourne about primary care system features which support or hinder best care for mild-to-moderate depression. The study differentiated between policy and reality 'on the ground'. METHODS: Two round Delphi technique methodology with four panels: GPs and patients in London and GPs and patients in Melbourne, to elicit views on the extent to which system features were reflected in policy, reflected in reality and were of value for best care. RESULTS: Four themes were generated: system and financing, responsibility and continuity, consultations and primary care team. Patient-centred care, having sufficient time during a consultation, and the GP-patient relationship extending over time were rated highly by all panels. Panellists differentiated between policy and reality on a number of features. CONCLUSIONS: The Australian system does not guarantee continuity of care with practitioner or practice but patients took steps to see the same doctor for depression. There was a difference in the way London and Melbourne panels responded to finance-related statements. There was a tendency for panellists to value aspects of their own system and to fail to see possibilities of other systems.

Walters P, Ashworth M, Tylee A. · Health Service and Population Research Department, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. · Br J Psychiatry. · Pubmed #18757984 No free full text.

Abstract: BACKGROUND: Antidepressant prescribing should reflect need. The Quality and Outcomes Framework has provided an opportunity to explore factors affecting antidepressant prescribing in UK general practice. AIMS: To explore the relationship between physical illness, social deprivation, ethnicity, practice characteristics and the volume of antidepressants prescribed in primary care. METHOD: This was an ecological study using data derived from the Quality and Outcomes Framework, the Informatics Collaboratory of the Social Sciences, and Prescribing Analyses and CosT data for 2004-2005. Associations were examined using linear regression modelling. RESULTS: Socio-economic status, ethnic density, asthma, chronic obstructive pulmonary disease and epilepsy explained 44% of the variance in the volume of antidepressants prescribed. CONCLUSIONS: Lower volumes of antidepressants are prescribed in areas with high densities of Black or Asian people. This may suggest disparities in provision of care. Chronic respiratory disease and epilepsy may have a more important association with depression in primary care than previously thought.

Reed C, Monz BU, Perahia DG, Gandhi P, Bauer M, Dantchev N, Demyttenaere K, Garcia-Cebrian A, Grassi L, Quail D, Tylee A, Montejo AL. · Eli Lilly & Company Ltd., Erl Wood Manor, Windlesham, Surrey, UK. · J Affect Disord. · Pubmed #18603303 No free full text.

Abstract: BACKGROUND: Health-related quality of life (HRQoL) data in depression are limited. We studied the impact of antidepressant (AD) treatment on HRQoL outcomes in depressed patients and investigated factors associated with these outcomes in routine practice settings. METHODS: The Factors Influencing Depression Endpoints Research (FINDER) study was a 6-month, European, prospective, observational study, designed to estimate HRQoL in 3468 adult patients with a clinically diagnosed episode of depression at baseline and at 3 and 6-months after commencing AD treatment. HRQoL was assessed by the Medical Outcome Short-Form (36) Health Survey (SF-36) and European Quality of Life-5 Dimensions (EQ-5D). Regression analysis identified baseline and treatment variables independently and significantly associated with HRQoL outcomes. RESULTS: Most HRQoL improvement occurred within 3 months of starting treatment. Better HRQoL outcomes were strongly associated with fewer somatic symptoms at baseline, AD treatment taken and not switching within AD groups. Education and occupational status were also important. Depression variables (number of previous depressions and current episode duration) were consistently associated with worse HRQoL outcomes. Self-rated depression severity was associated with poorer outcomes on the SF-36 mental component only. LIMITATIONS: As this was an observational study, the important finding that between and within AD group switching impacted HRQoL will need to be investigated in more controlled settings. CONCLUSIONS: Receiving an AD treatment was associated with large improvements in HRQoL, but switching within AD groups was consistently associated with poorer outcomes. Somatic symptoms, including painful symptoms, are often present in depressed patients and appear to negatively impact HRQoL outcomes.

Tylee A, Haddad M. · Department of Population & Health Service Research, King's College, London, UK. · Epidemiol Psichiatr Soc. · Pubmed #18333426 No free full text.

Abstract: AIMS: This paper aims to describe current trends in the UK primary care management of common mental disorders and explore the appropriateness of differing management approaches in light of the course and common complications of these disorders. METHODS: It highlights key findings concerning the course and comorbidity of depression to indicate that depression and associated mental illnesses may often form part of more complex patterns of ill health and that these conditions have a clear potential for chronicity. A narrative review of studies providing detail of depression prevalence in selected comorbid conditions is presented for this purpose. CONCLUSION: The presentation and course of common mental disorders indicate organizational changes in health service delivery, and--for a sizeable patient group--the use of chronic disease management strategies.

Bauer M, Monz BU, Montejo AL, Quail D, Dantchev N, Demyttenaere K, Garcia-Cebrian A, Grassi L, Perahia DG, Reed C, Tylee A. · Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany. · Eur Psychiatry. · Pubmed #18164600 No free full text.

Abstract: Antidepressant prescribing patterns and factors influencing the choice of antidepressant for the treatment of depression were examined in the Factors Influencing Depression Endpoints Research (FINDER) study, a prospective, observational study in 12 European countries of 3468 adults about to start antidepressant medication for their first episode of depression or a new episode of recurrent depression. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed antidepressant (63.3% patients), followed by serotonin-norepinephrine reuptake inhibitors (SNRIs, 13.6%), but there was considerable variation across countries. Notably, tricyclic and tetracyclic antidepressants (TCAs) were prescribed for 26.5% patients in Germany. The choice of the antidepressant prescribed was strongly influenced by the previous use of antidepressants, which was significantly associated with the prescription of a SSRI (OR 0.64; 95% CI 0.54, 0.76), a SNRI (OR 1.49; 95% CI 1.18, 1.88) or a combination of antidepressants (OR 2.78; 95% CI 1.96, 3.96). Physician factors (age, gender, speciality) and patient factors (severity of depression, age, education, smoking, number of current physical conditions and functional syndromes) were associated with initial antidepressant choice in some models. In conclusion, the prescribing of antidepressants varies by country, and the type of antidepressant chosen is influenced by physician- as well as patient-related factors.

Garcia-Cebrian A, Bauer M, Montejo AL, Dantchev N, Demyttenaere K, Gandhi P, Grassi L, Monz BU, Perahia DG, Quail D, Tylee A. · Eli Lilly and Company Limited, Lilly Research Centre, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey GU20 6PH, UK. · Eur Psychiatry. · Pubmed #18086518 No free full text.

Abstract: Factors influencing outcomes of depression in clinical practice, especially health-related quality of life (HRQoL), are poorly understood. The Factors Influencing Depression Endpoints Research (FINDER) study is a European prospective, observational study designed to estimate the HRQoL of adults with a clinically diagnosed depressive episode at baseline, and 3 and 6 months after commencing antidepressant medication. We report here the study design and baseline patient characteristics. HRQoL was assessed by the 36-item Short-Form Health Survey (SF-36) and European Quality of Life-5 Dimensions (EQ-5D). Patient ratings on Hospital Anxiety and Depression Scale (HADS) and pain Visual Analogue Scale (VAS) were also obtained. Results (n=3468) showed that SF-36 mental component summary (mean 22.2) was more than two SDs below general population norms (mean 50.0) and one SD below clinical depression norms (mean 34.8); the physical component summary (mean 46.1) was similar to general population (mean 50.0) and clinical depression norms (mean 45.0). Mean EQ-5D scores were also lower than general population norms. Mean HADS-Depression and -Anxiety subscores were 12.3 and 13.0, respectively. Fifty-six percent of patients reported an overall pain VAS score of at least 30mm and 70% of these patients had no physical explanation for their pain. Further investigation into factors associated with HRQoL in depression after treatment initiation is warranted.

Walters P, Tylee A, Fisher J, Goldberg D. · Department of Health Services and Population Research, Institute of Psychiatry, King's College London, London, UK. · Med Educ. · Pubmed #17908117 No free full text.

Abstract: CONTEXT: Many patients in primary care somatise psychological distress. Training general practitioners (GPs) to manage somatisation has been shown to lead to improvements in their management of these patients. However, the training has been intensive and conducted by psychiatrists, making it impractical for widespread use. The aim of this research was to determine the effectiveness of a teaching package in improving the ability of GP registrars to manage patients who somatise, when taught by GP vocational course tutors within the constraints of a general practice vocational training scheme. METHODS: This was a before-and-after training evaluation of GP registrars' skills. A total of 22 GP registrars and 6 GP course organisers were recruited from 3 GP vocational training schemes. The GP trainees had 2 videotaped consultations with trained actors role-playing patients with somatised depression, before and 1 month after training. RESULTS: There was a significant overall improvement in the ability of GP registrars to manage patients who somatise (mean scores on a 4-point Likert scale: pre-training 1.4 [standard deviation, SD, 0.6]; post-training 2.2 [SD 0.9]; P = 0.002). General practice registrars improved their ability to use a negotiating style of consultation (skill present in 8/22 pre-training, 16/22 post-training; P = 0.02) and also demonstrated more empathy during the 'consultation' after training (mean scores on a 5-point Likert scale: pre-training 2.3 [SD 1.0]; post-training 3.0 [SD 0.8]; P = 0.03). CONCLUSIONS: Using a structured training package, it is possible for GP vocational course tutors to successfully teach GP registrars to manage patients who somatise psychological distress. Given limited resources for teaching in terms of cost and time, this training package could have important implications for training medical staff.

Norton J, De Roquefeuil G, Boulenger JP, Ritchie K, Mann A, Tylee A. · Institut National de la Santé et de la Recherche Médicale (INSERM), U888, Hôpital La Colombière, Pavillon 42, 39 av. Charles Flahault, BP 34493, 34093 Montpellier Cedex 5, France. · Gen Hosp Psychiatry. · Pubmed #17591504 No free full text.

Abstract: OBJECTIVES: The objectives of this study were to establish provisional psychiatric diagnoses using the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PHQ) and to describe family practitioner (FP) case recognition, survey-day prescription of anxiolytic and antidepressant medications and overall consumption rates (medication use). METHODS: Between October 2003 and April 2004, 1151 consecutive patients (> or = 18 years old) of 46 FPs practicing in and around the city of Montpellier, France, completed the PHQ. During the consultation, FPs rated the severity of any psychiatric disorder. RESULTS: PHQ prevalence rates (FP case recognition percentages are given in parentheses) were as follows: 10.9% (36%) for probable alcohol abuse/dependence; 11.3% (40%) for somatoform disorder; 9.1% (75%) for major depression; 7.4% (42%) for other depressive disorders; 7.5% (69%) for panic disorder; and 6% (69%) for other anxiety disorders. The prescription rate for all study patients was 11.3%, ranging from 6.2% for those without a PHQ disorder to 30.3% for those with a PHQ diagnosis of anxiety or depression to 48.2% for FP-recognized cases. The estimated survey-day consumption rate for these medications was 19.4%. CONCLUSIONS: High consumption of anxiolytic and antidepressant medications in France is confirmed but not explained either by higher prevalence rates of psychiatric disorders as compared with other locations or by unusually high survey-day prescription rates. A possible explanation would be the organization of the French health care system, which has multiple sources for obtaining medication.