CNS Drugs

, Volume 15, Issue 1, pp 59–83 | Cite as

The Economics of Selective Serotonin Reuptake Inhibitors In Depression

A Critical Review
  • Lori Frank
  • Dennis A. Revicki
  • Sonja V. Sorensen
  • Ya-Chen Tina Shih
Review Article


The prevalence of depression and the high costs associated with its treatment have increased interest in pharmacoeconomic evaluations of drug treatment, particularly in the 1990s as the use of selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) expanded substantially. This review presents results from specific studies representing the key study designs used to address the pharmacoeconomics of SSRI use: retrospective administrative database analyses, clinical decision analysis models, and randomised clinical trials. Methodological considerations in interpreting results are highlighted.

In retrospective administrative database analyses, most comparisons have been made between SSRIs and tricyclic antidepressants (TCAs). A few studies have addressed differences between SSRIs. The studies focused on healthcare cost (to payer) and cost-related outcomes (e.g. treatment duration, drug switching). Although SSRIs are generally associated with higher drug acquisition costs than are TCAs, total healthcare costs are at least offset, if not decreased, by reductions in costs associated with use of SSRIs. Although studies from the early 1990s show some advantage for fluoxetine, the results are limited by use of data from shortly after the introduction of paroxetine and sertraline; studies from the mid-1990s on that compare drugs within the SSRI class show general equivalence in terms of cost. Important methodological advances are occurring in retrospective studies, with selection bias and other design limitations being addressed statistically.

Clinical decision analysis models permit flexibility in terms of ability to specify different alternative treatment scenarios and varying durations. Sensitivity analysis aids interpretability, although model inputs are limited by data availability. Results from short term (1 year duration or less) studies comparing SSRIs and TCAs suggest that SSRIs are more cost effective or that there is no difference. Longer term studies (lifetime Markov models) focus more on the impact of maintenance antidepressant therapy and show more mixed results, generally favouring SSRIs over TCAs. The results indicate that the effect of SSRIs is mainly through prevention of relapse. Important assumptions of these models include fewer serious adverse effects and lower treatment discontinuation rates with SSRIs.

Naturalistic clinical trials provide greater generalisability than traditional randomised clinical trials. One naturalistic trial found that nearly half of TCA-treated patients switched to another antidepressant within 6 months; only 20% of SSRI-treated patients switched. Cost differences between groups were minimal. These studies indicate few differences in medical costs, depression outcomes and health-related quality of life between TCAs and fluoxetine, although fewer fluoxetine-treated patients switched treatment.


Fluoxetine Medical Cost Paroxetine Imipramine Sertraline 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    US Department of Health and Human Services. Mental health: a report of the Surgeon General. Rockville (MD): US Department of Health and Human Services, 1999Google Scholar
  2. 2.
    Regier DA, Boyd JH, Burke JD, et al. One-month prevalence of mental disorders in the United States: based on five epidemiologic catchment area sites. Arch Gen Psychiatry 1988; 45(11): 977–86PubMedCrossRefGoogle Scholar
  3. 3.
    Blazer DG, Kessler RC, McGonagle KA, et al. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry 1994; 151(7): 979–86PubMedGoogle Scholar
  4. 4.
    Weissman MM, Bruce ML, Lef PJ, et al. Affective disorders. In: Robins LN, Regier DA, editors. Psychiatric disorders in America: the epidemiologic catchment area study. New York: The Free Press, 1991; 53–80Google Scholar
  5. 5.
    Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Study. Arch Gen Psychiatry 1994; 51: 8–19PubMedCrossRefGoogle Scholar
  6. 6.
    Greenberg PE, Stiglin LE, Finkelstein SN, et al. The economic burden of depression in 1990. J Clin Psychiatry 1993; 54: 405–18PubMedGoogle Scholar
  7. 7.
    West R. Depression. London: Office of Health Economics, 1992Google Scholar
  8. 8.
    Murray CJ, Lopez AD. Evidence-based health policy — lessons from the Global Burden of Disease Study. Science 1996; 274: 740–3PubMedCrossRefGoogle Scholar
  9. 9.
    Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. J Am Med Assoc 1989; 262: 914–9Google Scholar
  10. 10.
    Broadhead EW, Blazer DG, George LK, et al. Depression, disability days and days lost from work in a prospective epidemiologic survey. JAMA 1990; 264: 2524–8PubMedCrossRefGoogle Scholar
  11. 11.
    Johnson J, Weissman MM, Klerman GL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA 1992; 267: 1478–83PubMedCrossRefGoogle Scholar
  12. 12.
    Mintz J, Mintz LI, Arruda MJ, et al. Treatments of depression and the functional capacity to work. Arch Gen Psychiatry 1992; 49: 761–8PubMedCrossRefGoogle Scholar
  13. 13.
    Spitzer RL, Kroenke K, Linzer M, et al. Health-related quality of life in primary care patients with mental disorders: results from the PRIME-MD 1000 study. JAMA 1995; 274(19): 1511–7PubMedCrossRefGoogle Scholar
  14. 14.
    Hays RD, Wells KB, Sherbourne CD, et al. Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Arch Gen Psychiatry 1995; 52: 11–9PubMedCrossRefGoogle Scholar
  15. 15.
    Revicki DA, Simon GE, Chan K, et al. Depression, health-related quality of life, and medical cost outcomes of receiving recommended levels of antidepressant treatment. J Fam Pract 1998; 47: 446–52PubMedGoogle Scholar
  16. 16.
    Kazis LE, Miller DR, Clark J, et al. Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study. Arch Intern Med 1998; 158(6): 626–32PubMedCrossRefGoogle Scholar
  17. 17.
    Covinsky KE, Fortinsky RH, Palmer RM, et al. Relation between symptoms of depression and health status outcomes in acutely ill hospitalized older persons. Ann Intern Med 1997; 126(6): 417–25PubMedGoogle Scholar
  18. 18.
    VonKorff M, Ormel J, Katon WJ, et al. Disability and depression among high utilizers of health care. Arch Gen Psychiatry 1992; 49: 91–100CrossRefGoogle Scholar
  19. 19.
    Revicki DA, Wood M. Health state utilities of patients with depression. J Affect Disord 1998; 48: 25–36PubMedCrossRefGoogle Scholar
  20. 20.
    Simon G, Ormel J, VonKorff M, et al. Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry 1995; 152: 352–7PubMedGoogle Scholar
  21. 21.
    Depression Guideline Panel. Depression in primary care. Vol. 2, Treatment of major depression. Clinical Practice Guideline, No. 5. AHCPR Publication No. 93-0551. Rockville, MD: US Department of Health and Human Services, Agency for Health Care Policy and Research, 1993Google Scholar
  22. 22.
    Song F, Freemantle N, Sheldon T, et al. Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. BMJ 1993; 306: 683–7PubMedCrossRefGoogle Scholar
  23. 23.
    Workman E, Short D. Atypical antidepressants versus imipramine in the treatment of major depression: a meta-analysis. J Clin Psychiatry 1993; 54: 5–12PubMedGoogle Scholar
  24. 24.
    Montgomery S, Henry J, McDonald G, etal. Selective serotonin reuptake inhibitors: meta-analysis of discontinuation rates. Int Clin Psychopharmacol 1994; 9: 47–53PubMedCrossRefGoogle Scholar
  25. 25.
    Greenberg R, Bornstein RF, Zborowski MJ, et al. A meta-analysis of fluoxetine outcome in the treatment of depression. J Nerv Ment Dis 1994; 182: 547–51PubMedCrossRefGoogle Scholar
  26. 26.
    Canadian Coordinating Office for Health Technology Assessment. Selective serotonin reuptake inhibitors (SSRIs) for major depression. Part I, Evaluation of the clinical literature. Part II, The cost-effectiveness of SSRIs in treatment of depression. CCOHTA Report 1997: 3E. Ottawa: Canadian Coordinating Office for Health Technology Assessment, 1997Google Scholar
  27. 27.
    Hotopf M, Lewis G, Normand C. Are SSRIs a cost-effectiveness alternative to tricyclics? Br J Psychiatry 1996; 168(4): 404–9PubMedCrossRefGoogle Scholar
  28. 28.
    Mulrow CD, Williams JW, Trivedi M, et al. Treatment of depression: newer pharmacotherapies. Evidence Report/Technology Assessment No. 7. AHCPR Publication No. 99-E014. Rockville, MD: Agency for Health Care Policy and Research, Feb 1999Google Scholar
  29. 29.
    Aguglia E, Casacchia M, Cassano GB, et al. Double-blind study of the efficacy and safety of sertraline versus fluoxetine in major depression. Int Clin Psycholpharmacol 1993; 8: 197–202CrossRefGoogle Scholar
  30. 30.
    Schone W, Ludwig M. A double-blind study of paroxetine compared with fluoxetine in geriatric patients with major depression. J Clin Psychopharmacol 1993; 13: 34S–9SPubMedGoogle Scholar
  31. 31.
    Tignol J. A double-blind, randomized, fluoxetine-controlled, multicenter study of paroxetine in the treatment of depression. J Clin Psychopharmacol 1993; 13: 18S–22SPubMedCrossRefGoogle Scholar
  32. 32.
    Preskorn SH. Comparison of the tolerability of bupropion, fluoxetine, imipramine, nefazodone, paroxetine, sertraline, and venlafaxine. J Clin Psychiatr 1995; 56 Suppl. 6: 12–21Google Scholar
  33. 33.
    Kapur S, Mieczkowski T, Mann JJ. Antidepressant medications and the relative risk of suicide attempt and suicide. JAMA 1992; 268: 3441–5PubMedCrossRefGoogle Scholar
  34. 34.
    Olfson M, Klerman GL. Trends in the prescription of antidepressants by office-based psychiatrists. Am J Psychiatr 1993; 150: 571–7PubMedGoogle Scholar
  35. 35.
    Preskorn SH, Burke M. Somatic therapy for major depressive disorder: selection of an antidepressant. J Clin Psychiatr 1992; 53 ( Suppl. ): 5–18Google Scholar
  36. 36.
    Glaser M. Annual Rx survey. Drug Top 1997; 141: 45–53Google Scholar
  37. 37.
    Sclar DA, Robison LM, Skaer TL, et al. Trends in the prescribing of antidepressant pharmacotherapy: office-based visits, 1990–1995. Clin Ther 1998; 20: 871–84PubMedCrossRefGoogle Scholar
  38. 38.
    Revicki DA, Smith RA, Sorensen SV. Evaluating the cost-effectiveness of antidepressant therapies: decision analysis modeling vs randomized clinical trials. Econ Neurosci 1999; 1: 45–51Google Scholar
  39. 39.
    Nuijten MJC. Pharmacoeconomics in European decision-making. Value Health 1999; 2: 319–22PubMedCrossRefGoogle Scholar
  40. 40.
    Drummond M, Dubois D, Garattini L, et al. Current trends in the use of pharmacoeconomics and outcomes research in Europe. Value Health 1999; 2: 323–32PubMedCrossRefGoogle Scholar
  41. 41.
    Langley PC, Sullivan SD. Pharmacoeconomic evaluations guidelines: guidelines for drug purchasers. J Manag Care Pharm 1996; 2: 671–7Google Scholar
  42. 42.
    Revicki DA, Luce BR. Pharmacoeconomics research applied to psychopharmacology development and evaluation. Psychopharmacol Bull 1995; 31: 57–65PubMedGoogle Scholar
  43. 43.
    Hargreaves WA, Shumway M, Hu TW, et al. Cost-outcome methods for mental health. San Diego: Academic Press, 1998Google Scholar
  44. 44.
    Gold MR, Siegel JE, Russell LB, et al., editors. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996Google Scholar
  45. 45.
    Revicki DA, Frank L. Pharmacoeconomic evaluation in the real world: effectiveness versus efficacy studies. Pharmacoeconomics 1999; 15(5): 423–34PubMedCrossRefGoogle Scholar
  46. 46.
    Simon GE, VonKorff M, Heiligenstein JH. Initial antidepressant choice in primary care. Effectiveness and cost of fluoxetine vs tricyclic antidepressants. JAMA 1996; 275(24): 1897–902Google Scholar
  47. 47.
    Simon GE, Heiligenstein J, Revicki D, et al. Long-term outcomes of initial antidepressant drug choice in a ‘real world’ randomized clinical trial. Arch Fam Med 1999; 8: 319–25PubMedCrossRefGoogle Scholar
  48. 48.
    Boyer P, Danion JM, Bisserbe JC, et al. Clinical and economic comparison of sertraline and fluoxetine in the treatment of depression. A 6-month double-blind study in a primary-care setting in France. Pharmacoeconomics 1998; 13 (1 Pt2): 157–69PubMedCrossRefGoogle Scholar
  49. 49.
    Drummond MF, Stoddart G, Torrance GW. Methods for the evaluation of health care programmes. Oxford: Oxford University Press, 1987Google Scholar
  50. 50.
    Lave JR, Frank RG, Schulberg HC, et al. Cost-effectiveness of treatments for major depression in primary care practice. Arch Gen Psychiatry 1998; 55: 645–51PubMedCrossRefGoogle Scholar
  51. 51.
    Stewart A. Choosing an antidepressant: effectiveness based pharmacoeconomics. J Affect Disord 1998; 48(2–3): 125–33PubMedCrossRefGoogle Scholar
  52. 52.
    Croghan TW, Obenchain RL, Crown WE. What does treatment of depression really cost? Although treating a patient with depression is expensive, the bulk of the cost is for care of accompanying illnesses. Health Aff 1998 Jul/Aug; 17(4): 198–208CrossRefGoogle Scholar
  53. 53.
    Hylan TR, Crown WH, Meneades L, et al. Tricyclic antidepressant and selective serotonin reuptake inhibitors antidepressant selection and health care costs in the naturalistic setting: a multivariate analysis. J Affect Disord 1998; 47: 71–9PubMedCrossRefGoogle Scholar
  54. 54.
    McCombs JS, Nichol MB, Stimmel GL. The role of SSRI anti-depressants for treating depressed patients in the California Medicaid (Medi-Cal) program. Value Health 1999; 2(4): 269–80PubMedCrossRefGoogle Scholar
  55. 55.
    Obenchain RL, Melfi CA, Croghan TW, et al. Bootstrap analyses of cost effectiveness in antidepressant pharmacotherapy. Pharmacoeconomics 1997 May; 11(5): 464–72PubMedCrossRefGoogle Scholar
  56. 56.
    Russell JM, Berndt ER, Miceli R, et al. Course and cost of treatment for depression with fluoxetine, paroxetine, and sertraline. Am J Manag Care 1999; 5(5): 597–606PubMedGoogle Scholar
  57. 57.
    Sclar DA, Robison LM, Skaer TL, et al. Antidepressant pharmacotherapy: economic outcomes in a health maintenance organization. Clin Ther 1994; 16(4): 715–29PubMedGoogle Scholar
  58. 58.
    Sclar DA, Skaer TL, Robison LM, et al. Economic appraisal of citalopram in the management of single-episode depression. J Clin Psychopharmacol 1999; 195 Suppl. 1: 47S–54SPubMedCrossRefGoogle Scholar
  59. 59.
    Sclar DA, Skaer TL, Robison LM, et al. Economic outcomes with antidepressant pharmacotherapy: a retrospective intentto-treat analysis. J Clin Psychiatry 1998; 59 Suppl. 2: 13–7PubMedGoogle Scholar
  60. 60.
    Sclar DA, Robison LM, Skaer TL, et al. Antidepressant pharmacotherapy: economic evaluation of fluoxetine, paroxetine and sertraline in a health maintenance organization. J Int Med Res 1995; 23: 395–412PubMedGoogle Scholar
  61. 61.
    Simon GE, Fishman P. Cost implications of initial antidepressant selection in primary care. Pharmacoeconomics 1998 Jan; 13 (1 Pt 1): 61–70PubMedCrossRefGoogle Scholar
  62. 62.
    Skaer TL, Sclar DA, Robison LM, et al. Economic valuation of amitriptyline, desipramine, nortriptyline, and sertraline in the management of patients with depression. Curr Ther Res 1995 Jun; 56(6): 556–67CrossRefGoogle Scholar
  63. 63.
    Thompson D, Hylan TR, McMullen W, et al. Predictors of a medical-offset effect among patients receiving antidepressant therapy. Am J Psychiatry 1998 Jun; 155(6): 824–7PubMedGoogle Scholar
  64. 64.
    Conner TM, Crismon ML, Still DJ. A critical review of selected pharmacoeconomic analyses of antidepressant therapy. Ann Pharmacother 1999; 33(3): 364–72PubMedCrossRefGoogle Scholar
  65. 65.
    Sturm R, Wells KB. How can care for depression become more cost-effective? JAMA 1995; 273(1): 51–8PubMedCrossRefGoogle Scholar
  66. 66.
    Claxton AT, Chawla AJ, Kennedy S. Absenteeism among employees treated for depression. J Occup Environ Med 1999 Jul; 41(7): 605–11PubMedCrossRefGoogle Scholar
  67. 67.
    Fairman KA, Drevets WC, Kreisman JJ, et al. Course of anti-depressant treatment, drug type, and prescriber’s specialty. Psychiatr Serv 1998 Sep; 49(9): 1180–6PubMedGoogle Scholar
  68. 68.
    Hutchins DS, Klein EG, Signa WF, et al. Selective serotonin reuptake inhibitor utilization patterns: consistency across research designs. Clin Ther 1998; 20(4): 797–805PubMedCrossRefGoogle Scholar
  69. 69.
    Streja DA, Hui RL, Streja E, et al. Selective contracting and patient outcomes: a case study of formulary restrictions for selective serotonin reuptake inhibitor antidepressants. Am J Manag Care 1999; 5(9): 1133–42PubMedGoogle Scholar
  70. 70.
    Dunner DL, Greden JF, Greist JH, et al. Serotonin: the first decade. Special use of SSRIs. J Clin Psychiatry 1999; 17 Monograph 3: 42–52Google Scholar
  71. 71.
    Davis R, Wilde MI. Sertraline. A pharmacoeconomic evaluation of its use in depression. Pharmacoeconomics 1996 Oct; 10(4): 409–31Google Scholar
  72. 72.
    Weinstein MC, Fineberg HV. Clinical decision analysis. Philadelphia: W.B. Saunders Co, 1980Google Scholar
  73. 73.
    Pauker SG, Kassirer JP. Medical progress — decision analysis. N Engl J Med 1987; 316: 250–8PubMedCrossRefGoogle Scholar
  74. 74.
    Hylan TR, Kotsanos JG, Andersen JS, et al. Comparison of a decision analytic model with results from a naturalistic economic clinical trial: an application to evaluating alternative antidepressants. Am J Manag Care 1996; 2: 1211–23Google Scholar
  75. 75.
    Halpern MT, Luce BR, Brown RE, et al. Health and economic outcomes modeling practices: a suggested framework. Value Health 1998; 1: 131–47PubMedCrossRefGoogle Scholar
  76. 76.
    Buxton MJ, Drummond MF, Van Hout BA, et al. Modelling in economic evaluation: an unavoidable fact of life. Health Econ 1997; 6: 217–27PubMedCrossRefGoogle Scholar
  77. 77.
    Halpern MT, McKenna M, Hutton J. Letter to the editors. Health Econ 1998; 7: 741–2PubMedCrossRefGoogle Scholar
  78. 78.
    Bentkover JD, Feighner JP. Cost analysis of paroxetine versus imipramine in major depression. Pharmacoeconomics 1995; 8(3): 223–32PubMedCrossRefGoogle Scholar
  79. 79.
    Einarson TR, Arikian S, Sweeney S, et al. A model to evaluate the cost-effectiveness of oral therapies in the management of patients with major depressive disorders. Clin Ther 1995; 17(1): 136–53PubMedCrossRefGoogle Scholar
  80. 80.
    Einarson TR, Addis A, Iskedjian M, et al. Pharmacoeconomic analysis of venlafaxine in the treatment of major depressive disorder. Pharmacoeconomics 1997; 12 (2 pt 2): 286–96PubMedCrossRefGoogle Scholar
  81. 81.
    Jonsson B, Bebbington PE. What price depression? The cost of depression and the cost-effectiveness of pharmacological treatment. Br J Psychiatry 1994; 164: 665–73PubMedCrossRefGoogle Scholar
  82. 82.
    Kind P, Sorensen J. Modeling the cost-effectiveness of the prophylactic use of SSRIs in the treatment of depression. Int Clin Psychopharmacol 1995; 10 Suppl. 1: 41–8CrossRefGoogle Scholar
  83. 83.
    LaPierre Y, Bentkover J, Schainbaum S, et al. Direct cost of depression: analysis of treatment costs of paroxetine versus Imipramine in Canada. Can J Psychiatry 1995; 40(7): 370–7PubMedGoogle Scholar
  84. 84.
    Le Pen C, Levy E, Ravily V, et al. The cost of treatment dropout in depression. A cost-benefit nefazodone v. imipramine. Br J Psychiatry 1996; 168(6): 768–71Google Scholar
  85. 85.
    Nuijten MJC, Hardens M, Souetre E, et al. Process analysis comparing the cost-effectiveness of maintenance therapy with citalopram versus standard therapy in major depression. Pharmacoeconomics 1995; 8(2): 159–68PubMedCrossRefGoogle Scholar
  86. 86.
    Stewart A. Antidepressant pharmacotherapy: cost comparison of SSRIs and TCAs. Br J Med Econ 1994; 7: 67–79Google Scholar
  87. 87.
    Anton AF, Revicki DA. The use of decision analysis in the pharmacoeconomic evaluation of an antidepressant: a cost-effective study of nefazodone. Psychophamacol Bull 1995; 31(2): 249–58Google Scholar
  88. 88.
    Freemantle N, House A, Son F, et al. Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide. BMJ 1994; 309: 249–53PubMedCrossRefGoogle Scholar
  89. 89.
    Hatziandreu EJ, Brown RE, Revicki DA, et al. Cost utility of maintenance treatment of recurrent depression with sertraline versus episodic treatment with dothiepin. Pharmacoeconomics 1994; 5(3): 249–64PubMedCrossRefGoogle Scholar
  90. 90.
    Revicki DA, Brown RE, Palmer W, et al. Modeling the cost-effectiveness of antidepressant treatment in primary care. Pharmacoeconomics 1995; 8(6): 524–40PubMedCrossRefGoogle Scholar
  91. 91.
    Revicki DA, Brown RE, Keller MB, et al. Cost-effectiveness of newer antidepressants compared with tricyclic antidepressants in managed care settings. J Clin Psychiatry 1997; 58: 47–58PubMedCrossRefGoogle Scholar
  92. 92.
    Drummond MF, Davies LM. Economic analysis alongside clinical trials: revisiting the methodological issues. Int J Technol Assess Health Care 1991; 7: 561–73PubMedCrossRefGoogle Scholar
  93. 93.
    Simon G, Wagner E, Vonkorff M. Cost-effectiveness comparisons using ‘real world’ randomized trials: the case of the new antidepressant drugs. J Clin Epidemiol 1995; 48(3): 363–73PubMedCrossRefGoogle Scholar
  94. 94.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed., rev. Washington, DC: American Psychiatric Association, 1987Google Scholar
  95. 95.
    Sclar DA, Robison LM, Skaer TL, et al. What factors influence the prescribing of antidepressant pharmacotherapy? An assessment of national office-based encounters. Int J Psychiatry Med 1998; 28(4): 407–19PubMedCrossRefGoogle Scholar
  96. 96.
    Sclar DA, Skaer TL, Robison LM, et al. Economic appraisal of antidepressant pharmacotherapy: critical review of the literature and future directions. Depress Anxiety 1998; 8 Suppl. 1: 121–7CrossRefGoogle Scholar
  97. 97.
    Wells KB, Sherbourne C, Schoenbaum M, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA 2000; 283: 212–20PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  • Lori Frank
    • 1
  • Dennis A. Revicki
    • 1
  • Sonja V. Sorensen
    • 1
  • Ya-Chen Tina Shih
    • 1
  1. 1.Center for Health Outcome ResearchMEDTAP InternationalBethesdaUSA

Personalised recommendations