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Antidepressant treatment in general practice--an interview study
J U Rosholm1, L F Gram, N Damsbo
1Department of Clinical Pharmacology, Odense University, Denmark.
Objective:
To elucidate potential problems concerning the use of antidepressants (AD) in general practice.
Design:
Cross-sectional, descriptive interview study.
Setting:
General practices, Odense, Denmark.
Subjects:
Random sample consisting of 98 AD users from 12 general practices.
Main Outcome Measures:
Indication for AD treatment, justification of the treatment, duration of AD treatment, daily dose of AD, side effects, Hamilton depression rating, WONCA score.
Results:
The primary indication for AD treatment was depression (72 patients), partly regular depression (therapeutic/prophylactic treatment) (n = 39), partly depressive tendencies (n = 32) (1 unknown). Median treatment duration was 3 years; 25% had been in treatment for more than 10 years. The general practitioners judged the treatment problematic/unacceptable in 23 cases, largely because of uncertain indication or because other or no treatment was considered better for the patient. The daily doses of AD were generally low. Side effects were modest. The patients often had a relatively high depression score and poor status according to the WONCA-scale.
Conclusions:
The use of low doses, long duration of treatment, and uncertainty about the relevance of the treatment are important features of the use of AD by general practitioners. There seems to be a discrepancy between the use of AD in general practice and the scientifically-based recommendations.