Telephone Psychotherapy and Care Management for DepressionTelephone Psychotherapy and Care Management for Depression

To the Editor: In the study by Dr Simon and colleagues,¹ patients initiating antidepressant treatment were randomly assigned to receive telephone care management alone, telephone care management with telephone psychotherapy, or usual care. I am concerned that the group receiving usual care was characterized by no contact until 6 weeks had elapsed since the start of medication. Following the initiation of antidepressants there may be an increased risk of suicidal ideation, particularly during the first month.² The United States Department of Health and Human Services guideline for treatment of major depression in primary care recommends that patients check in every 1 to 2 weeks for the initial 6 to 8 weeks of medication treatment.³ It therefore appears that the usual care in this study setting was suboptimal. The superior efficacy of the telephone interventions in this study may simply be the result of regular follow-up ensuring compliance and timely assessment of response to treatment.

In addition, although the study only compares telephone interventions with usual care, the discussion compares telephone interventions with standard, in-person psychotherapy. For example, the authors suggest that telephone interventions better address several barriers to dissemination of effective depression treatments, allow clinicians to engage patients better, and provide greater privacy. It would seem that these conclusions can be made only if there is a control group receiving in-person psychotherapy. In fact, it is a common practice for clinicians to provide in-person psychotherapy as an adjunct to medications for patients with more severe depression.^{4 - 5}