Antidepressant prescription for depression in general practice in the Netherlands

Objective: To evaluate diagnoses and the prescription of antidepressants dr ugs for depression, based on data from 1993 to 1998 related to consultation s for depression in general practice in the Netherlands. Method: An exploratory analysis of data provided by IMS Health. Consecutive annual representative samples of 640 GPs regularly registered data on morb idity and (drug) treatment for specific medical problems in special booklet s for a period of one week. The data refer to consultations for depression. The diagnoses were initially based on ICD-9 criteria and later ICD-10 crit eria for depression. Main outcome measures: Number of diagnoses of depression and number of pres criptions for antidepressants. Results: The number of first consultations for depression rose gradually, f rom 909 in 1993 (95% CI: 774 to 1043), to 1,482 (CI: 1292 to 1672) in 1998: an increase of 63%. For an individual GP, this represents an increase from 18 to 30 in first consultations for depression. The number of prescription s for antidepressants also increased, mainly during repeat consultations: a 278% increase, from 3,708 in 1993 to 14,024 in 1998 (CIs: 3,504 to 3,912 a nd 13,252 to 14,796). Antidepressants were prescribed during the first cons ultation 564 times in 1993 compared with 1,080 times in 1998. The first con tact with a GP for depression led to an antidepressant prescription in 62% of cases in 1993 and 73% in 1998. Although the guidelines issued by the Dut ch College of General Practitioners in 1994 recommended tricyclic antidepre ssants (TCAs) for the treatment of depression, paroxetin, fluoxetin, and mi rtazapin (SSRIs) accounted for 56% of the prescribed antidepressants. Conclusion:Between 1993 and 1998, GPs in the Netherlands prescribed increas ingly more antidepressants, and they prescribed more SSRIs than TCAs. Furth ermore, GPs diagnose depression more frequently and the number of repeat co nsultations has increased.