Antidepressants in general practice - Too much or too little?

With a source in a prescription database study and the literature, the following points concerning the use of antidepressants (ADs) in general practice are discussed: More than half of patients are given ADs for indications other than depression. The 12-month prevalence of AD treatment is 1.6%. Compared with a prevalence of depression estimated at between 2 and 10%, this suggests undertreatment of depression and many depressed patients not diagnosed in general practice. Substantially lower doses of ADs are used in general practice than in hospitalized patients, whose treatment is adjusted by therapeutic drug monitoring. Some patients are treated for very short periods, whereas others are treated for years without reconsideration of the indication. Use of the new ADs (SSRI and moclobemide) has increased considerably since their introduction in the late 1980s. The indications for AD treatment in general practice may have increased, as has been seen in the United States. In conclusion, ADs are on the one hand over-used in general practice, since they are used for indications other than depression and for long periods. On the other hand, ADs are underused, since many depressed patients are not treated at all, some are treated for very short periods and very low doses are employed.