Inadequate dosaging in general practice of tricyclic vs. other antidepressants for depression

Several prescription database studies suggest major differences between ant idepressants in the proportion of patients in general practice treated with doses likely to elicit a true drug response. However, in these studies it has been difficult to differentiate prescriptions for depression from those for other indications, or to distinguish lower starting doses from the fin al treatment doses. We investigated possible differences between types of a ntidepressant in the proportions of patients receiving adequate treatment d oses for depression from the primary health care services of Helsinki. Doct ors at 22 (71%) of the 31 health centres in Helsinki were surveyed with reg ard to their antidepressant prescriptions over a period of 2 working weeks. There were marked differences in dosaging adequacy between the various typ es of antidepressant prescribed for depression at final treatment doses. Ov erall, 71% of the prescriptions for the tricyclic antidepressants, but only 13% of those for the other antidepressants, mainly selective serotonin reu ptake inhibitors, were for low doses that are generally considered to be in effective (P < 0.001). These findings endorse the emerging perception that, in general practice, tricyclic antidepressants are usually prescribed for depression in too low doses, and that a greater reliance on other antidepre ssants would probably improve the effectiveness of treatment in primary hea lth care.