CHOICE OF ANTIDEPRESSANTS - QUESTIONNAIRE SURVEY OF PSYCHIATRISTS ANDGENERAL-PRACTITIONERS IN 2 AREAS OF SWEDEN

Objective-To identify factors that affect physicians' choice of specif ic antidepressant drugs in order to evaluate the validity of epidemiol ogical studies of the risks (particularly suicide) and benefits of dif ferent compounds. Design-Questionnaire survey of 264 psychiatrists and general practitioners in an urban area and a rural area of Sweden wit h validation of data by independent prescription surveys. Setting-Urba n area of greater Stockholm and rural county of Jamtland, Sweden. Subj ects-228 physicians (86%) who answered the questionnaire. Main outcome measures-The drugs used as first line drugs of choice, as drugs of ch oice in particularly severe depression, and as drugs of choice for dis orders other than depression. Results-Amitriptyline was the most commo n first line drug of choice among both psychiatrists and general pract itioners. The patterns of choice of antidepressants in the two areas a ccorded with prescribing patterns in two independent prescription surv eys. Amitriptyline was chosen even more frequently for severe depressi on and depression with severe insomnia. Clomipramine was chosen compar atively more often for depression with severe anxiety. Low toxicity co mpounds (mainly lofepramine, mianserin, and moclobemide) were more oft en the drug of choice in depression associated with overt risk of suic ide. Amitriptyline and clomipramine were used extensively for disorder s other than depression (40% and 54% of prescriptions, compared with 1 3-19% for some other major antidepressants). Conclusion-Patient groups treated with different antidepressant compounds may not be comparable with respect to diagnoses and severity of disease. In particular, lof epramine, mianserin, and moclobemide, and possibly amitriptyline, seem to be chosen more often for patients prone to suicide.