Table 4.

Physician's Reported Rationale for Overruling the Acute Treatment Depression Guidelines

Patient	Physician	Patient Age, Y (Gender)	Clinical Rationale
1	A	68 (M)	Myocardial infarction just prior to enrollment in study with continuing unstable angina. Hospitalized with a pulmonary embolus during acute phase treatment. (Had seen a psychiatrist in previous year, but wouldn't return)
2	A	36 (F)	Rapidly accelerating systematic lupus erythematosis, type 1 diabetes, and new onset heart failure with multiple hospitalizations and medications
3	B	52 (F)	Severe steroid-dependent asthma; multiple chronic medications including high doses of steroids
4	C	35 (F)	Physician did not believe patient had major depression. Had recently lost husband and only son in an auto accident
5	D	74 (F)	Rapid worsening heart failure with multiple hospitalizations for pulmonary edema
6	E	60 (M)	AIDS with multiple complications and multiple medications
7	E	78 (F)	Metastatic breast cancer, chronic pain, recently lost husband who had helped her manage complicated medication regimen
8	E	43 (F)	Physician initially believed patient was not depressed. (By 6 months patient had completed a guideline-concordant course of antidepressant medication)
9	E	45 (F)	Patient with multiple medications. Remained on starting dose of paroxetine; did not increase dose because both patient and physician satisfied with response
10	F	34 (M)	Recent and rapid progression of HIV to AIDS with multiple medications
11	G	50 (F)	Severe cirrhosis of liver, recurrent bleeding of esophageal varices, scheduled for portal-caval shunt during acute phase
12	H	28 (M)	Recent hemicolectomy for Crohn's Disease, metastatic testicular cancer. (By 6 months, patient had received guideline-concordant courses of both antidepressant medication and psychotherapy.)