Antidepressant prescribing by specialty and treatment of premenstrual dysphoric disorder

Because of limitations in diagnosis coding, it is difficult to determine which products are used to treat premenstrual dysphoric disorder. To better understand treatment of premenstrual dysphoric disorder, we examined the antidepressant prescribing behavior of obstetrician/gynecologists as a marker for premenstrual dysphoric disorder treatment and compare these use patterns to psychiatrists and primary care physicians. Over the past quarter, only three percent of antidepressants were prescribed by obstetrician/gynecologists as compared to 51 percent by primary care physicians and 20 percent by psychiatrists. Obstetrician/ gynecologists more frequently use selective serotonin reuptake inhibitors (69% compared to 58% in primary care and 48% in psychiatry) and are more likely to choose an selective serotonin reuptake inhibitors agent indicated for the treatment of premenstrual dysphoric disorder (e.g., fluoxetine, paroxetine, sertraline): 66 percent versus 59 percent for both primary care physicians and psychiatrists. Use of desvenlafaxine was slightly elevated in obstetrician/ gynecologists as compared to primary care physicians (0.3% vs. 0.1% of total antidepressants, respectively); however, psychiatrists prescribed more desvenlafaxine than either group: 0.4 percent of total antidepressant prescriptions. Discussion of this data is provided.