Publication date

GPs motivations of prescribing antidepressants and their practical relevance.

Volkers, A., Jong, A. de, Braspenning, J.C.C., Bakker, D. de, Dijk, L. van. GPs motivations of prescribing antidepressants and their practical relevance. European Journal of Public Health: 2004, 14(4 Suppl.) 89. Abstract. 12 th Annual EUPHA meeting: Urbanisation and health: new challenges in health promotion and prevention in Oslo, Norway, 7-9 october 2004.
Background: Insight in the motivations of prescribing antidepressants may contribute to advance the efficiency of the current, large antidepressant prescription rate. Less is known about why general practitioners (GPs) treat patients with antidepressants or not and choose modern SSRIs instead of the classical tricyclic antidepressants (TCAs). Aim: To explore the motivations of and reasons for prescribing antidepressants and to determine the relevance of each motivation/reason in concrete patients. Methods: Based on a semi-structured interview in 22 GPs we distracted motivations of prescribing antidepressants. Subsequently, 67 other GPs filled in for concrete patients with depression or anxiety disorder whether or not these motivations were relevant for choosing an antidepressant treatment in general or a specific antidepressant (case-control study). The GPs in the case-control study were participating in the National Information Network GPs (LINH) and recorded all patient contacts and prescriptions in their electronic medical system. Results: The interviews showed that clinical characteristics, guidelines, costs and patient’s preference for (non-)medical treatment played a role in prescribing antidepressants. In the case-control study, severity and duration of symptoms, expected effectiveness and effectiveness in the past were most frequently mentioned as reasons for prescribing antidepressants. Antidepressants were not prescribed in case of a treatment with a non-medical treatment or when no effectiveness was expected. The most frequently reported reasons for prescribing SSRIs and TCAs were similar (e.g. expected effectiveness, effectiveness in the past and Iess side effects). Another relevant motivation in case of TCAs are costs. Other relevant motivations in case of SSRIs are friendly use and good compliance. Conclusions: Clinical characteristics are more frequently the reason for prescribing antidepressants than the preference of the patient. The large prescription rate of SSRIs may be related to the GPs’ believe that SSRIs are friendly in use and result in good compliance.