Contents of general practitioner-patient consultations in the treatment of depression

BACKGROUND: Counseling of patients is an indispensable part of any drug treatment and even more so in the treatment of depression. OBJECTIVE: To describe the content of counseling additional to prescribing an antidepressant drug. SETTING: Sixty-three general practices from all over Germany. PATIENTS: Three hundred two patients with the diagnosis of either a depressive episode or a recurrent depressive disorder. MEASUREMENTS: Assessment of the content of the physician-patient encounter by content analysis following the pivotal topic method. DESIGN: Qualitative study embedded in a drug utilization study on mirtazapine. RESULTS: In the initial sessions general practitioners focused on building a good therapeutic alliance, assessing the symptoms of illness, explaining the course of treatment, assuring medication compliance, and discussing problems of life. In the middle phase of treatment, physicians also dealt with building a therapeutic alliance, medication compliance, and the progress and course of illness. In the last phase relapse prevention was an important topic. Psychological topics were more important than medication topics. Almost no importance was given to management of side effects, change of cognitions, or suicidal tendencies. LIMITATIONS: No information is available on how content was actually discussed. Only encounters were observed where an antidepressant was prescribed. CONCLUSIONS: Counseling plays an important part in day-to-day encounters of general practitioners. Pharmacotherapy is embedded in comprehensive psychological care. Training programs for general practitioners should be specific in respect to different tasks and parts of the physician-patient encounter (e.g., building a therapeutic alliance, support for life problems or change of cognitions).