Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-19T08:21:05.937Z Has data issue: false hasContentIssue false
  • English
  • Français

The Treatment of Depression: Prescribing Patterns of Antidepressants in Primary Care in the UK

Published online by Cambridge University Press:  02 January 2018

J. M. Donoghue  and
A. Tylee
J. M. Donoghue*
Affiliation:
Pharmacy Department, Wirral Hospital (NHS) Trust
A. Tylee
Affiliation:
Division of General Practice and Primary Care, St George's Hospital Medical School, Hunter Wing, Cranmer Terrace, London SW17 0RE
*
J. M. Donoghue, Pharmacy Department, Wirral Hospital Trust, Clatterbridge Hospital, Bebington, Wirral L63 4JY. Fax: 0151 727 5276
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Consensus has been achieved about how depression should be treated in primary care, and guidelines have been issued by the Royal Colleges of General Practitioners and Psychiatrists, and by the British Association for Psychopharmacology. One of the principal recommendations is to prescribe antidepressant medicine at effective doses. This study was established to investigate how current prescribing practices in primary care compared with these guidelines.

Method

Information on prescribing of antidepressant medicines was obtained using three independent data sources: Prescribing Analysis and Cost (PACT) data; medical notes; and a large, computerised patient record database.

Results

Data were obtained on populations in excess of 1.5 million people, and over 80 000 prescriptions were reviewed. All three data sources showed very similar patterns of prescribing, in particular that as many as 88% of prescriptions for older tricyclic antidepressants are prescribed by GPs at doses below those recommended by the consensus guidelines. Newer antidepressants – lofepramine and the SSRIs – are prescribed comparatively well.

Conclusions

Prescribing of antidepressants by GPs is not in line with the consensus recommendations on dosage. This may have major educational implications for GPs. A pragmatic approach to improve prescribing in the short term may be to advocate the use of lofepramine or the SSRIs as first line treatment for depression. This study validates the use of PACT data as a useful audit tool in this area of clinical practice.

Type
Papers
Information
The British Journal of Psychiatry , Volume 168 , Issue 2 , February 1996 , pp. 164 - 168
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

British Association for Psychopharmacology (1993) Guidelines for treating depressive illness with antidepressants. Journal of Psychopharmacology, 7, 19–23.Google Scholar
British National Formulary (1995) 29, 165–169. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain.Google Scholar
Buckley, N. A., Dawson, A. H., Whyte, I. M., et al (1994) Greater toxicity in overdose of dothiepin than of other TCAs. Lancet, 343, 159–162.Google Scholar
Cassidy, S. & Henry, J. (1987) Fatal toxicity of antidepressant drugs in overdose. British Medical Journal, 295, 1021–1024.CrossRefGoogle ScholarPubMed
Freemantle, N., Long, A., Mason, J., et al (1993) The treatment of depression in primary care. Effective Health Care, 5, 1–12.Google Scholar
Henry, J. A., Alexander, C. A. & Sener, E. K. (1995) Relative mortality from overdose of antidepressants. British Medical Journal, 310, 221–224.Google Scholar
Isacsson, G., Holmgren, P., Wasserman, D., et al (1994) Use of antidepressants among people committing suicide in Sweden. British Medical Journal, 308, 506–509.CrossRefGoogle ScholarPubMed
Johnson, D. A. W. (1974) A study of use of antidepressant medication in general practice. British Journal of Psychiatry, 125, 186–192.Google Scholar
Jonsson, B. & Bebbington, P. E. (1994) What price depression? The cost of depression and the cost effectiveness of pharmacological treatment. British Journal of Psychiatry, 164, 665–673.Google Scholar
Old Age Depression Interest Group (1993) How long should the elderly take antidepressants? A double-blind placebo-controlled study of continuation/prophylaxis therapy with dothiepin. British Journal of Psychiatry, 162, 175–182.Google Scholar
Paykel, E. S. & Priest, R. G. (1992) Recognition and management of depression in general practice: Consensus Statement. British Medical Journal, 305, 1198–1202.CrossRefGoogle ScholarPubMed
Rosholm, J.-U., Hallas, J. & Gram, L. F. (1993) Outpatient utilization of antidepressants: A prescription database analysis. Journal of Affective Disorders, 27, 21–28.CrossRefGoogle ScholarPubMed
Rutz, W., Walinder, J., Eberhard, G., et al (1989) An educational program on depressive disorders for general practitioners on Gotland: background and evaluation. Acta Psychiatrica Scandinavica, 79, 19–26.Google Scholar
Sclar, D. A., Robison, L. M., Skaer, T. L., et al (1994) Antidepressant pharmacotherapy: economic outcomes in a Health Maintenance Organisation. Clinical Therapeutics, 16, 715–30.Google Scholar
Scott, J. & Eccleston, D. (1991) Prediction, treatment and prognosis of chronic primary major depression. International Clinical Psychopharmacology, 6 (Suppl. 1), 41–49.CrossRefGoogle ScholarPubMed
Thompson, C. & Thompson, C. M. (1989a) The prescription of antidepressants in general practice I: a critical review. Human Psychopharmacology, 4, 91–102.Google Scholar
Thompson, C. & Thompson, C. M. (1989b) Prescribing of antidepressants in general practice II: A placebo controlled trial of low dose dothiepin. Human Psychopharmacology, 4, 191–204.Google Scholar
Tyrer, P. (1988) Prescribing psychotropic drugs in general practice. British Medical Journal, 296, 588.Google Scholar
Wilkinson, G. (1994) Can suicide be prevented? British Medical Journal, 309, 860–862.CrossRefGoogle ScholarPubMed
Woster, P. S., Montgomery, P. A. & Guthrie, S. K. (1994) Tricyclic antidepressant prescribing by psychiatrists and other physicians. American Journal of Hospital Pharmacy, 51, 381–384.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.