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Patients prescribed antidepressants from psychiatrists are more likely to receive and continue higher doses

Public awareness campaigns urge people to seek help for depression and the pharmaceutical industry promotes antidepressants with few side effects. Using a national survey's 2001-2003 data, researchers found 1 in 10 people received prescriptions for these drugs from primary care physicians or psychiatrists in the course of a year. They examined the antidepressant prescribing patterns of psychiatrists and primary care providers for 928 patients ages 18 and older.

More than 70 percent of patients reported receiving their antidepressant prescription from their primary care provider in the past year. These patients were typically at least 65 years old, female, and residents of non-urban areas. Nearly 30 percent of patients received their prescriptions for antidepressants from psychiatrists. The patients tended to meet established criteria for major depressive, bipolar, panic, or post-traumatic stress disorders or social phobia and have a larger number of mood and anxiety symptoms.

These findings may be explained in part by the primary care providers' tendency to refer more severely ill patients to psychiatrists, the authors suggest. Compared with primary care providers' patients, psychiatrists' patients were also more likely to continue taking their antidepressants for more than 3 months. This may be because of the differences in the type of patients the providers see or the psychiatrists' ability to keep patients engaged in antidepressant therapy.

Psychiatrists' patients also tended to receive higher doses of antidepressants than primary care providers' patients. This conservative approach by primary care providers may be because of side effects associated with older tricyclic antidepressants. This study was funded in part by the Agency for Healthcare Research and Quality (HS16097).

See "National patterns in antidepressant treatment by psychiatrists and general medical providers: Results from the National Comorbidity Survey Replication," by Ramin Mojtabai, M.D., Ph.D., M.P.H., and Mark Olfson, M.D., M.P.H., in the July 2008 Journal of Clinical Psychiatry 69(7), pp. 1064-1074.

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