Use and misuse: Antidepressants in general practice

Depressive disorders are the most common psychiatric illnesses encountered in general practice. The majority of cases are managed exclusively by GPs, prescribing antidepressant medications with or without concurrent counselling or other treatments. There is persistent evidence that in relation to existing treatment guidelines, GPs prescribe antidepressants at inadequate doses for inadequate periods. The Dorset Antidepressant Side-Effects Initiative was designed to discover some of the issues that influence GPs' prescribing of antidepressants. Whilst results indicate that GPs have reasonably good understanding of the characteristics of the two main classes of antidepressant medications, they are much more likely to underprescribe older tricyclics than SSRIs. The differing side-effect profiles of these classes of antidepressant play a significant role in prescribing behaviour. However, the choice of antidepressant is also influenced by the age of the GP, and the type of drug prescribed influences the way in which the GP manages complaints of adverse effects.