Objective: To determine the psychiatric characteristics of a sample of primary care patients receiving extended treatment with selective serotonin reuptake inhibitors (SSRIs) as well as to assess the appropriateness of extended treatment.
Study design: A prospective case series of patients (convenience sample) assessed with survey, psychological testing, interview, and medical record review.
Methods: Participants (n = 39) were patients in a health maintenance organization primary care setting receiving treatment with SSRI-type antidepressants for 12 months or longer, with no psychiatric evaluation or treatment immediately before commencement of antidepressant therapy. Each participant completed measures of self-destructive behavior and personality disturbance, underwent a clinical psychiatric interview, and had their medical record reviewed to determine psychiatric diagnoses by the primary care physician at the initiation of antidepressant treatment.
Results: On psychiatric interview, 64.1% of participants were diagnosed with major depression, the majority recurrent (46.2% of the entire sample); 46.2% with dysthymia; and 38.5% with panic disorder. Psychiatric morbidity in this sample was reflected by recurrent depressive episodes, long-standing depression, comorbid psychiatric diagnoses on interview (average of 1.8 diagnoses per participant), self-harm behaviors, and personality pathology. Seventy-seven percent of primary care diagnoses gleaned from medical records reflected depressive diagnoses. The approximate "match" rate for a depression-spectrum diagnosis between psychiatric interviewer and primary care physicians was 90%; however, on psychiatric interview, 16.7% of participants had bipolar disorder and 38.5% had panic disorder, which were not noted in the primary care medical record.
Conclusions: Patients in primary care settings receiving extended treatment with SSRIs may have complex psychopathology for which long-term antidepressant treatment appears appropriate.