Primary care patients taking antidepressants who received intensive team-based telemedicine care reported fewer drug side effects compared with patients who received less intensive care. The research is published in Psychiatric Services in Advance, a publication of the American Psychiatric Association.

Most people with depression do not experience the full positive effects of antidepressants until 6 to 8 weeks after beginning treatment. Side effects cause many patients to stop taking antidepressants prematurely. Side effects can include gastrointestinal problems, difficulty sleeping, sexual dysfunction and headaches. Teresa J. Hudson, PharmD, of the Psychiatric Research Institute at the University of Arkansas for Medical Sciences, Little Rock, Arkansas and colleagues looked at the effectiveness of two models of care in reducing side effects: a telemedicine-based team led by an off-site care manager and less intensive practice-based collaborative care.

All of the study participants received 12 months of evidence-based care coordinated by depression care managers (registered nurses or licensed practical nurses) who contacted patients every two weeks during the acute treatment, and every four weeks during continuation treatment. The encounters included symptom monitoring, patient education, addressing barriers, goal planning, monitoring and promotion of medication adherence, and monitoring and management of side effects (such as advising the patient to take medications with meals to avoid nausea). The primary care group contact was either face to face or by telephone. All of the telemedicine group patient encounters were by telephone.

In the primary care based intervention the depression care managers worked directly with primary care providers to develop and implement treatment plans with no direct involvement from mental health specialists. The telemedicine-based intervention involved five types of providers: an on-site primary care provider, an off-site depression care manager, and an off-site telemedicine team with a pharmacist, psychologist and psychiatrist. The telemedicine team held weekly conference calls to discuss new patients, patients not responding to treatment and any medication related problems.

The telemedicine-based group reported significantly fewer side effects at 6, 12 and 18 months. The study authors note the reduced side effects were likely the result of care managers' increased focus on monitoring side effects and helping patients understand and manage side effects. "Care managers working with a telemedicine-based clinical team can reduce the number of side effects that patients attribute to antidepressant medications," the authors concluded.