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Martin B. Keller, MD; Gerald L. Klerman, MD; Philip W. Lavori, PhD; Jan A. Fawcett, MD; William Coryell, MD; Jean Endicott, PhD

JAMA. 1982;248(15):1848-1855.

Abstract
We report on the treatment received by 217 patients in the community with a diagnosis of major depressive disorder of at least one month's duration. Only a low proportion of subjects received intensive treatment with antidepressant medication or electroconvulsive therapy, as judged by research standards and current clinical teaching. Specific associations emerge between treatment and several clinical, sociodemographic, and diagnostic variables; however, taken together these variables account for only a small fraction of the variance in treatment received. Even among patient subgroups based on severity and long duration of illness, high proportions did not receive adequate therapeutic trials. Substantial differences are found in treatment across community centers that are not attributable to variation in the clinical characteristics of patients. We conclude that more research is needed to determine how patients and practitioners contribute to this phenomenon of low intensity of somatic treatment.

(JAMA 1982;248:1848-1855)

Author Affiliations
From the Departments of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Drs Keller, Klerman, and Lavori); Rush-Presbyterian-St Luke's Medical Center, Chicago (Dr Fawcett); the University of Iowa, Iowa City (Dr Coryell); the New York State Psychiatric Institute, New York (Dr Endicott); and the Department of Electrical Engineering, Massachusetts Institute of Technology, Cambridge, Mass (Dr Lavori).

Footnotes
Reprint requests to Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114 (Dr Keller).

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