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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
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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 

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