Predictors of antidepressant prescription and early use among depressed outpatients

Objective: The rates of antidepressant recommendation and use were determin ed in outpatients with major depression receiving services in mental health clinics. Site of service and the patients' sociodemographic and clinical c haracteristics were investigated as possible predictors. Method: Patients a dmitted to six outpatient clinics were recruited through a two-stage sampli ng procedure. Patients with major depressive disorder (N = 124) according t o the Structured Clinical Interview for DSM-IV-Patient Edition were assesse d at admission and 3 months later. Results: Drug therapy was recommended fo r most patients (71%), and minimal use (at least 1 week) was recorded for 5 9% of the subjects. White patients were nearly three times as likely to rec eive a recommendation for antidepressants. Antidepressant recommendation wa s also associated with severity of depressed mood, recent medication use, a nd clinic type. Recent antidepressant use was the only variable that predic ted whether the patient actually took the recommended medication. Conclusio ns: Many patients with depression seeking treatment at community mental hea lth clinics do not receive antidepressant drug therapy. The offer of medica tion is predicted by patient ethnicity, clinic type, and symptom severity. Minority patients are less likely to be offered antidepressant treatment.