The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared

Background: Antidepressants are commonly prescribed by general practitioner s as treatment for depression. Controversy exists as to the effectiveness i n everyday use of the older tricyclic antidepressants (TCAs) when compared to the newer selective serotonin reuptake inhibitors (SSRIs). Aim: To inves tigate the patterns of current prescribing of antidepressants for the treat ment of depression and compare TCAs with the newer SSRIs. Method: The study population was patients attending 151 computerised general practices from throughout the United Kingdom between 1991 and 1996. Patients with new pres criptions for antidepressants and a diagnosis of depression were identified . Age and gender distributions, prescribed doses and drop-out rates were in vestigated. Results: During the study period 9.8% of patients received a pr escription for an antidepressant, there was a 40% increase in the prescribi ng rate of TCAs and a 460% increase in SSRI prescribing. TCAs were initiall y prescribed in sub-therapeutic doses. More than 50% of patients ceased tak ing their antidepressants within 6 weeks of starting treatment. Fluoxetine and paroxetine were more likely to be prescribed for a therapeutic period t han were other antidepressants. Conclusions: General practitioners should p rescribe a therapeutic dose of antidepressant for a recognised therapeutic period to ensure that patients with depression receive the most effective t reatment. (C) 2000 Elsevier Science B.V. All rights reserved.