Learn More. Some studies considered prescriptions meet DSM criteria, while others stress inadequate use. The importance of biological and psychosocial determinants of GP prescription behaviour remains little explored. During a week chosen at random, 28 GPs collected the AD prescriptions made within the previous six months, regardless of the reason for the patient contact. Bio psychosocial and AD treatment characteristics were recorded for all patients.
In a random sample of 50 patients, patient characteristics were assessed via a structured face-to-face interview with the GP. The frequency of AD prescription was 8. The GPs initiated Patients had from 1 to 9 conditions, showing a high level of multi-morbidity. There was a strong influence of past medical history and contextual problems, such as work related problems. AD prescription is related to complex contextual situations and multi-morbid patients.
GPs use a bio psycho social approach, rather than a purely biological assessment. Awareness of these influences could improve prescription by GPs. Antidepressant AD sales increased sevenfold in industrialized countries from to and have remained rather stable since then [ 1 - 3 ].
The AD consumption is very high in France 9. This high level of consumption could be explained by a greater demand for medical care and an increased number of patients treated for depression [ 10 , 11 ]. The increasing rate of long-term treatment of depressed people could also explain this consumption [ 12 ].
ADs are also prescribed for other mental disorders, such as anxiety [ 13 ] and for minor depression [ 3 , 14 ]. ADs could also be adequately used in treating non-psychiatric conditions such as pain [ 15 ]. They are also prescribed in an inadequate manner, such as a too short duration of treatment [ 20 ] or in a sub-therapeutic dosage [ 3 ]. All these discrepancies suggest a lack of data, probably related to the complex real-life situations seen in primary care: Qualitative research has revealed that GPs usually prescribe ADs for non-psychiatric or mixed conditions, sometimes off-label, influenced by overall patient characteristics [ 21 , 22 ].
The main aim of this pilot study is to more precisely describe the importance of these biological and psychosocial determinants as they relate to GPs in their daily practice. AD prescriptions and the characteristics of patients who had been prescribed an AD in the last six months were gathered.
The study was conducted in the Normandy region of France, in the northwestern area of the country. Like many regions, it includes industrialized cities e.
Rouen, Le Havre as well as rural areas and has an overall population of 1. Access to the health care system does not differ from the usual standard of the country: In France, GPs are the first medical contact for the patients and provide open access to its users, dealing with all health problems regardless of the age, sex, or any other characteristic of the person concerned. A three year specialized curriculum, or official equivalency is mandatory to practice as a GP.
All GPs from our local research network were invited to participate in the study. Those invited all worked full-time at a primary ambulatory care practice, only seeing outpatients. None of the physicians worked in specialized or secondary care settings e. The GPs collected the data during a week chosen at random between December and March We included all patients who had been prescribed an AD within the previous six months, including renewals and new prescriptions, regardless of the reason for contact, and whether or not this prescription was continued later on.
Patient characteristics gender, age, socio-professional category and marital status and the AD treatment characteristics dosage, estimated starting date, and initiator of the prescription were recorded. In order to focus in depth on all biological and psychosocial characteristics, we randomly selected from each GP two patients who had been prescribed an AD within the previous six months.
The selection was stopped when a total of 50 patient files had been drawn. The assessment included risk factors for depression and on-label and off-label conditions for AD prescription. Those characteristics were related to the psycho-social context of the patient e. The aim was to weight the relative influence of the factors for an AD prescription according to the GP himself.
We wanted to point out the influence of less prevalent factors than psychiatric disorders e. Three categories - on-going problems, patient history, and biomedical conditions - were distinguished.
Secondly, we assessed the influence of these determinants based on the interviews with the prescribing GPs. Any outlier and missing data were tracked. To get an indication of the weight of the influencing factors for the 50 randomly chosen patients, the sum of all individual determinant scores, rated from 0 to 2 for each patient, was calculated. The mean number and range of influencing factors per patient as well as the modus score for each influencing factor was determined.
We determined the strength of influence by dividing the score of influence by the prevalence for each factor. The local ethics committee CPP Nord-Ouest stated that an authorization was not required for this non-interventional study.
Among the 56 GPs invited, 28 6 females and 22 males agreed to participate. The mean age was Nine worked in rural practice, and 14 were mentoring students. The mean duration of practice was During the study week, the GPs saw 3, patients, of whom 8.
Two hundred twenty-nine patients were female Their mean age was 54 [18—91]. Overall, patients The participating GPs themselves initiated prescriptions During the study week every GP had nearly three patients 2. The results are described in Table 1. Half of the patients had no professional activity and 17 had work-related problems.
Nine patients had no diagnosis of any psychiatric condition. According to their GP, the other 41 had a psychiatric diagnosis: major depressive episode, depressive episode or anxiety, or sometimes a combination. Many of these conditions were related to pain. The prevalence of the conditions assessed and their most frequent influence score are shown in Table 2.
The relative influence for the most important of them is shown in Table 3. Among the contextual factors, work-related problems and recent bereavement showed both a high prevalence and strong influence on AD prescription. Within the past medical history, former AD prescription and depression were noticeably prevalent.
Fibromyalgia and neuropathic pain, though not so prevalent, nonetheless had a strong influence on the decision to prescribe an AD. Other chronic diseases for which an AD was prescribed included disability after a stroke and chronic cardiac failure. This study confirmed the high frequency of AD prescription in general practice.
Nevertheless, one third of the AD prescriptions were not initiated by the GPs, but were renewals. During the study week, each of the GPs saw an average of 11 patients taking ADs: On average eight of the patients were already taking the AD and the physician initiated the prescription for the other three. One patient in two had had a long-term prescription, more than one year, which is consistent with other studies [ 10 , 12 ].
The most prevalent and influential conditions were anxiety and depression, in contradiction with other studies [ 6 , 18 ]. Women were particularly affected. The fact that anxiety was an important reason for AD prescription must be highlighted, though anxiety is partly associated with depression. French health authorities have stigmatised the prescription of benzodiazepines by GPs and their level of prescription has stagnated [ 3 ], which has probably produced a shift away from benzodiazepines towards more AD prescriptions.
The influence of a past history of depression or previous AD prescription has also to be pointed out, as it was already suggested from our previous qualitative study [ 22 ]. It's important to note the treatment of depression is not as simple as receiving a prescription for an antidepressant.
The individual causes of depression are diverse and poorly understood. The medications used to treat it are just as diverse, so matching a drug with an individual is not a clear-cut process. When your doctor chooses your antidepressant , they will consider many factors to try to make this match.
These include your specific symptoms, any co-existing illnesses you have, your tolerance of side effects , and any medications you have previously tried. Treatment can take some time. It typically takes a few weeks to feel the full effect of your medication.
Antidepressants typically take at least four weeks to begin working and psychotherapy typically does not produce significant results for at least four to six weeks, depending on the type of therapy.
Be sure to communicate regularly with your doctor, especially if you are experiencing bothersome side effects. If you are noticing very little or no improvement in your symptoms after two to four weeks, your doctor may increase your dose, add another medication to increase its effect, or switch your medication. Get our printable guide to help you ask the right questions at your next doctor's appointment.
The most important thing to remember about seeking treatment for your depression symptoms is simply to speak up and ask. Depression is not a sign of weakness or laziness. It's a sign that something is out of balance. With proper treatment, which usually entails the two-pronged approach of medication and psychotherapy, you can feel well again. For more mental health resources, see our National Helpline Database.
Everything feels more challenging when you're dealing with depression. Get our free guide when you sign up for our newsletter. Centers for Disease Control and Prevention. Updated February 21, Maurer DM. Screening for depression. Am Fam Physician. National Institute of Mental Health. Updated February Mental health medications.
Updated October Your Privacy Rights. To change or withdraw your consent choices for VerywellMind. I'm willing to take medicine every day for at least 6 months, and maybe longer. Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now. How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps. Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. My symptoms are worse than the possible side effects of the medicines.
Is it possible to manage the side effects of antidepressants? Are you clear about which benefits and side effects matter most to you? Do you have enough support and advice from others to make a choice? Author: Healthwise Staff. Weinstock MD - Psychiatry. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use and Privacy Policy.
Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Depression: Should I Take an Antidepressant? Get the facts. Your options Take antidepressants to treat depression.
Don't take antidepressants. Key points to remember Taking medicine for your depression can help you get your life back to normal, especially if you also get counselling. But if your symptoms are mild, lifestyle changes and counselling may be all you need. The medicines won't change your personality. Antidepressants don't work right away. And you may need to try a few before you find one that works.
Side effects are one reason that people stop taking antidepressants. But talk to your doctor. There are many ways to manage side effects. And lowering the dose or changing medicines may also help.
Are you depressed? The symptoms of depression include a loss of interest in daily activities or feeling sad or hopeless and having at least four of the following symptoms: A change in eating patterns that causes either weight gain or weight loss Sleeping too much or not enough Feeling restless and unable to sit still, or feeling that moving takes a great effort Feeling tired all the time Feeling unworthy or guilty without an obvious reason Having problems concentrating, remembering, or making decisions Thinking often about death or suicide.
What are antidepressants? Antidepressants don't change your personality. They help your symptoms. How well do antidepressants work? What side effects can antidepressants cause? Side effects may vary depending on the medicine you take, but common ones include: Nausea.
Dry mouth. Loss of appetite. Diarrhea or constipation. Sexual problems loss of desire, erection problems. Trouble falling asleep, or waking a lot during the night. Weight gain.
Feeling nervous or on edge. Feeling drowsy in the daytime. What are other treatments for depression? Counselling Counselling is an important part of the treatment for depression. The types of counselling most often used for treatment of depression include: Cognitive-behavioural therapy , which teaches you how to become healthier by changing certain thought and behaviour patterns.
Interpersonal therapy , which focuses on your relationships and the problems they may be causing. Problem-solving therapy , which focuses on the problems you are facing and on helping you find solutions. Family therapy , which involves the entire family. Lifestyle changes There are also lifestyle changes you may be able to make that may help your depression symptoms: Eat healthy foods.
Don't drink alcohol. Get regular exercise. Get a good night's sleep. Get social support from family and friends. Try to keep a positive attitude—remember that feeling better takes time, and your mood will improve little by little.
Other treatment choices Besides counselling and lifestyle changes, there are some other treatments you can try: Alternative treatments such as massage therapy and yoga may help you get better faster and make your life better. You can try relaxation exercises at home to lower your stress. Complementary therapies are sometimes used for depression. Talk to your doctor before taking any of them, because they can interfere with other medicines.
Electroconvulsive therapy may be used to treat severe depression or depression that hasn't responded well to other treatment. It also may be a treatment choice for someone who cannot live with the side effects of antidepressants. Why might your doctor recommend antidepressants? Your doctor might suggest that you try antidepressants if: You have tried counselling and lifestyle changes, and they haven't worked. Your symptoms are bad enough that they interfere with your daily life.
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