General practitioners' perceptions of the tolerability of antidepressant drugs: a comparison of selective serotonin reuptake inhibitors and tricyclic antidepressants

Publisher Website
Google Scholar
Abstract
Objective: To examine inceptions and discontinuations of antidepressants in general practice. Design: An observational study analysing data from an ongoing cross sectional postal survey. Every three months a representative sample of 250 doctors recorded prescribing activity for four weeks. This provided 4000 general practitioner weeks of recording per year. Setting: A representative panel of general practitioners in England, Wales, and Scotland. Subjects: Patients who began a new course of an antidepressant or had their treatment stopped or changed by the general practitioner between 1 July 1990 and 30 June 1995. Main outcome measures: Numbers of patients prescribed a new course of antidepressant; numbers discontinuing treatment; the ratio of antidepressant discontinuations to antidepressant inceptions; reasons for discontinuation; proportion of switches to another antidepressant. Results: There were 13 619 inceptions and 3934 discontinuations of selective serotonin reuptake inhibitors and tricyclic antidepressants during the study. The number of newly prescribed courses of antidepressants increased by 116%, mostly due to an increase in prescribing of serotonin reuptake inhibitors. The ratio of total discontinuations to inceptions was significantly lower for serotonin reuptake inhibitors (22%) than for tricyclic antidepressants (33%). Differences persisted when controlled for age and sex of patients and severity of depression. However, there was more switching away from selective serotonin reuptake inhibitors when they failed (72%) than from tricyclic antidepressants (58%). Conclusions: Selective serotonin reuptake inhibitors are less likely than tricyclic antidepressants to be discontinued. A prospective study is needed in general practice to assess the implications of differences in discontinuation rates and switches on clinical and economic outcomes. The number of new prescriptions for antidepressants increased by 116% between 1990 and 1995, mostly due to increased prescribing of selective serotonin reuptake inhibitors In an observational study in general practice the ratio of antidepressant discontinuations to antidepressant inceptions was lower for selective serotonin reuptake inhibitors than for tricyclic antidepressants Data suggest that selective serotonin reuptake inhibitors are tolerated better in the general practice setting than tricyclic antidepressants However, there may be more switching away from selective serotonin reuptake inhibitors when they fail (72% in this series) than from tricyclic antidepressants (58%) Prospective studies are required in general practice to evaluate the implications of differences in discontinuation rates and switching on clinical and economic outcomes