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Am Fam Physician. 2002;65(2):294

In Great Britain, more than 90 percent of patients with depression are treated exclusively by general practitioners, and this condition accounts for approximately 10 percent of consultations. Self-help and cognitive-behavior approaches are an important element in the treatment of depression, and studies have shown that British patients tend to value psychologically based treatments in conjunction with or instead of pharmacotherapy. The Royal Colleges of General Practice and Psychiatry have produced an audio tape, “Coping with Depression,” that provides information, advice, a guide to support groups and resources, and exercises such as active scheduling, journaling, and the challenging of negative thoughts. Blenkiron studied the effectiveness of this tape in patients with depression.

Patients were selected by general practitioners to receive the tape if they met diagnostic criteria for depression, were physically able and willing to use the tape, and completed a baseline assessment including the Hospital Anxiety and Depression (HAD) questionnaire. Patients were instructed to use the tape for seven days. At the end of this period, patients completed assessments of the tape, including their use of the techniques it described, and repeated the HAD assessment. The physician for each participating patient was interviewed after the study regarding the usefulness of the tape.

Of the 71 participating patients, 50 returned all questionnaires and completed all assessments. Most patients (66 percent) used the tape on at least three occasions, and 40 percent reported that a friend or relative also listened to the tape at least once. Men used the tape significantly more often than women. Of patients who received information about depression from other sources, 85 percent reported that the tape was the most useful source of information. The tape had a significant positive effect on attitudes toward depression, and this effect was most pronounced in patients not taking antidepressant medication. By the end of the week, 30 patients reported trying at least one of the techniques described on the tape. Two thirds of patients assessed the tape as helpful, but no subgroup of particular benefit could be identified. The physicians also reported the tape as a useful adjunct to treatment, although several reported a patient selection bias in that they gave the tape to the more difficult patients. The main problem encountered by physicians was in securing return of the tapes.

The author concludes that well-prepared audiotapes provide a useful adjunct to the treatment of depression and may be more effective in men and in patients less likely to take medication or respond well to therapy. This study suggests that larger randomized, controlled trials are needed to confirm the efficacy of self-help tapes.

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