The appropriateness of antidepressant prescribing in primary care continues to elicit debate and regular research contributions.1,2 I carried out a single practice survey of depression management at a practice in south east London. The surgery’s electronic records were searched for patients who had been treated for a diagnosis of depression, with or without anxiety between the dates of 1 January 2000 to 21 February 2007. These subject-records were then searched for aspects of management that had been put in place with demographic details and management recorded. A total of 91 patients were returned from the search population by the electronic records database search engine, this amounted to 4.5% of the 2031 registered patients. The ratio of females to males in the cases was 2:1. The majority of patients were between the ages of 30 and 49 years, and more than three-quarters of the sample were of either of black or white ethnicity, with Asians making up 7% of the cohort. In terms of management, most (86%) of the patients had been treated with an antidepressant at some point. Interestingly, the most commonly prescribed agent was dothiepin, a tricyclic, which was prescribed in 27 of the cases.
This finding was interesting in relation to the NICE guidelines on management of depression, whose recommendations at the time of the study were that dothiepin should be commenced only by mental health professionals. The next most commonly used drug was the SSRI, paroxetine, used for 23 cases. Other agents used, in order of reducing frequency were: fluoxetine, venlafaxine, citalopram, mirtazepine, sertraline, and escitalopram. Of four patients on venlafaxine, two patients were found to have been in contact with secondary care, with two patients having no electronic record of secondary service contact. Thirty-six of the 91 patients received some form of further care after their initial point of contact with the GP, 19 receiving an outpatient psychiatric referral, eight being referred for counseling, and the rest being referred either to a CRISIS team, PCT psychotherapy services, Victim Support, Gamblers Anonymous, or an outpatient liaison psychiatry clinic. Overall, it appears that the pattern of UK antidepressant prescribing, even in relatively well resourced areas, remains patchy.
- © British Journal of General Practice, 2010.
