Factors affecting prescribing of the newer antidepressants

OBJECTIVE: TO survey various prescriber types and specialties to determine whether differences exist in prescribing patterns for the newer antidepress ants. DESIGN, SETTING, AND PARTICIPANTS: A survey about prescribing of the newer antidepressants was mailed to 1500 New York state licensed prescribers who were randomly selected from membership rosters. Nurse practitioners; physic ian assistants and physicians in family medicine, primary care, general pra ctice, and internal medicine; and psychiatrists were included. MAIN OUTCOME MEASURES: Prescriber responses regarding factors involved with choosing among the newer antidepressants. RESULTS: A total of 508 surveys (36%) were returned, of which 398 (29%) wer e acceptable for analysis. In choosing among the newer antidepressants, mos t prescribers ranked patient diagnosis and past success asa high priority, and free drug samples and drug-representative detailing as a law priority. The majority of each prescriber type preferred fluoxetine for major depress ion and depression associated with fatigue; paroxetine for concomitant anxi ety and depression, as well as for panic disorder; and sertraline for geria tric patients and patients with suicidal ideation. Differences existed betw een the prescriber groups when asked whether prescribing habits for the new er antidepressants were based on familiarity with a particular agent (p = 0 .0009) and on labeled indications (p = 0.002). CONCLUSIONS: This is the first study to demonstrate prescribing preferences for the newer antidepressants among different prescriber groups. Additiona l studies are needed to determine predictors of patient response to newer a ntidepressants and clinical guidelines for their use.