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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 . . . [Full Text of this Article]

Tawee Tanvetyanon, MD
tanvety@pol.net
Loyola University Chicago Stritch School of Medicine
Maywood, Ill

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