The treatment of depression: prescribing patterns of antidepressants in primary care in the UK
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.
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A few studies suggested that older antidepressants such as TCAs were more susceptible to be prescribed in low doses.
“A few studies suggested that older antidepressants such as TCAs were more susceptible to be prescribed in low doses (34, 38, 39), which was consistent with our study.”
Some studies revealed that low dose prescriptions were especially related to primary care physicians.
“Some studies further revealed that low dose prescriptions were especially related to primary care physicians, perhaps due to their concerns about the side effects related to TCAs, or the lack of confidence of those general practitioners (34, 38, 40).”
Cites
Recognition and management of depression in general practice: consensus statement
Paykel, E. S., & Priest, R. G. (1992) · BMJ · doi:10.1136/bmj.305.6863.1198 · Cited by 540 · see citing works
Relative mortality from overdose of antidepressants
Henry, J. A., Alexander, C., & Sener, E. K. (1995) · BMJ · doi:10.1136/bmj.310.6974.221 · Cited by 292 · see citing works
Fatal toxicity of antidepressant drugs in overdose.
Cassidy, S. L., & Henry, J. A. (1987) · BMJ · doi:10.1136/bmj.295.6605.1021 · Cited by 251 · see citing works
Jönsson, B., & Bebbington, P. (1994) · The British Journal of Psychiatry · doi:10.1192/bjp.164.5.665 · Cited by 222 · see citing works
How Long Should the Elderly Take Antidepressants?
Old Age Depression Interest Group, Jacoby, R. J., Lunn, A. D., Ardern, M., Bergmann, K., Conway, J., Cooling, N. J., Davies, G., Fisk, J., Gehlhaar, E., et al. (1993) · The British Journal of Psychiatry · doi:10.1192/bjp.162.2.175 · Cited by 155 · see citing works
Rutz, W., Wålinder, J., Eberhard, G., Holmberg, G., von Knorring, A. ‐., von Knorring, L., Wistedt, B., & Åberg‐Wistedt, A. (1989) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1989.tb09229.x · Cited by 143 · see citing works
Use of antidepressants among people committing suicide in Sweden
Isaccsson, G., Holmgren, P., Wasserman, D., & Bergman, U. (1994) · BMJ · doi:10.1136/bmj.308.6927.506 · Cited by 135 · see citing works
A Study of the Use of Antidepressant Medication in General Practice
Johnson, D. A. W. (1974) · The British Journal of Psychiatry · doi:10.1192/bjp.125.2.186 · Cited by 118 · see citing works
Greater toxicity in overdose of dothiepin than of other tricyclic antidepressants
Buckley, N. A., Dawson, A. H., White, I. M., et al. (1994) · The Lancet · doi:10.1016/s0140-6736(94)90940-7 · Cited by 103 · see citing works
Prescribing psychotropic drugs in general practice
Tyrer, P. (1988) · BMJ · doi:10.1136/bmj.296.6622.588 · Cited by 79 · see citing works
Montgomery, S., Bebbington, P., Cowen, P. J., Deakin, J. F. W., FREELING, P., Hallström, C., Katona, C., King, D., Leonard, B. E., Levine, S., et al. (1993) · Journal of Psychopharmacology · doi:10.1177/0269881193007001041 · Cited by 72 · see citing works
Thompson, C. M., & Thompson, C. M. (1989) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.470040305 · Cited by 53 · see citing works
Controversies in Management: Better treatment of mental illness is more appropriate aim
Wilkinson, G. (1994) · BMJ · doi:10.1136/bmj.309.6958.860 · Cited by 51 · see citing works
Outpatient utilization of antidepressants: a prescription database analysis
Rosholm, J.-U., Hallas, J., & Gram, L. F. (1993) · Journal of Affective Disorders · doi:10.1016/0165-0327(93)90092-x · Cited by 48 · see citing works
The prescription of antidepressants in general practice: I a critical review
Thompson, C., & Thompson, C. M. (1989) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.470040204 · Cited by 37 · see citing works
Overdose and Safety with Fluvoxamine
Henry, J. A. (1991) · International Clinical Psychopharmacology · doi:10.1097/00004850-199112003-00004 · Cited by 37 · see citing works
Treatment of depression in primary care.
Paykel, E. S., & FREELING, P. (1992) · BMJ · doi:10.1136/bmj.304.6838.1380-c · Cited by 22 · see citing works
Prediction, Treatment and Prognosis of Chronic Primary Major Depression
Scott, J. L., & ECCLESTON, D. (1991) · International Clinical Psychopharmacology · doi:10.1097/00004850-199107001-00006 · Cited by 10 · see citing works
Tricyclic antidepressant prescribing by psychiatrists and other physicians
Woster, P. S., Montgomery, P. A., & Guthrie, S. K. (1994) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/51.3.381 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Priest, R. G., Vize, C., Roberts, A., Roberts, M., & Tylee, A. (1996) · BMJ · doi:10.1136/bmj.313.7061.858 · Cited by 385 · see citing works
Self-citationAkhondzadeh, S., Tahmacebi‐Pour, N., Noorbala, A., Amini, H., Fallah‐Pour, H., Jamshidi, A., & Khani, M. (2005) · Phytotherapy Research · doi:10.1002/ptr.1647 · Cited by 298 · see citing works
Bollini, P., Pampaliona, S., Tibaldi, G., Kupelnick, B., & Munizza, C. (1999) · British Journal of Psychiatry · doi:10.1192/bjp.174.4.297 · Cited by 274 · see citing works
Peretti, S., Judge, R., & Hindmarch, I. (2000) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2000.tb10944.x · Cited by 236 · see citing works
Luo, Y., Kataoka, Y., Ostinelli, E. G., Cipriani, A., & Furukawa, T. A. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00035 · Cited by 206 · see citing works
Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study
Johnson, C. F., Macdonald, H. J., Atkinson, P., Buchanan, A. I., Downes, N., & Dougall, N. (2012) · British Journal of General Practice · doi:10.3399/bjgp12x658304 · Cited by 105 · see citing works
Patients' views of physical activity as treatment for depression: a qualitative study
Searle, A., Calnan, M., Lewis, G., Campbell, J., Taylor, A., & Turner, K. (2011) · British Journal of General Practice · doi:10.3399/bjgp11x567054 · Cited by 115 · see citing works
Taylor, M. J., Rudkin, L., & Hawton, K. (2005) · Journal of Affective Disorders · doi:10.1016/j.jad.2005.07.006 · Cited by 102 · see citing works
The Antidepressant Web: Marketing depression and making medicines work
Medawar, C. (1997) · International Journal of Risk and Safety in Medicine · doi:10.3233/jrs-1997-10203 · Cited by 92 · see citing works
Kendrick, T., Chatwin, J., Dowrick, C., Tylee, A., Morriss, R., Peveler, R., Leese, M., McCrone, P., Harris, T., Moore, M., et al. (2009) · Health Technology Assessment · doi:10.3310/hta13220 · Cited by 86 · see citing works
Self-citationClaxton, A. J., Li, Z., & McKendrick, J. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.177.2.163 · Cited by 68 · see citing works
Kuyken, W., Byford, S., Byng, R., Dalgleish, T., Lewis, G., Taylor, R., Watkins, E. R., Hayes, R., Lanham, P., Kessler, D., et al. (2010) · Trials · doi:10.1186/1745-6215-11-99 · Cited by 48 · see citing works
Bosmans, J. E., Schreuders, B., van Marwijk, H. W., Smit, J. H., van Oppen, P., & van Tulder, M. W. (2012) · BMC Family Practice · doi:10.1186/1471-2296-13-98 · Cited by 16 · see citing works
- Authors
- Donoghue, J. M., & Tylee, A.
- Affiliations
- Clatterbridge Hospital (GB)
- St George's Hospital (GB)
- Corresponding author
- Donoghue, J. M.
- ORCID
- Tylee, A.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 1996-02
- Volume
- 168
- Issue
- 2
- Pages
- 164-168
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2106075952
- Cited by
- 209
- References
- 19
- Citations by year
- 2026: 2 · 2024: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 4 · 2016: 3 · 2015: 1 · 2014: 5 · 2013: 3 · 2012: 3
- FWCI
- 15.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, antidepressant prescribing, prescribing patterns, primary care, guideline adherence, tricyclic antidepressants, lofepramine, selective serotonin reuptake inhibitors, dose optimization, general practitioners
- MeSH terms
- Antidepressive Agents, Depressive Disorder, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Utilization, United Kingdom, Humans, Medical Audit, Patient Care Team, Primary Health Care, Treatment Outcome, Practice Guidelines as Topic
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