‘A coal face option’: GPs' perspectives on the rise in antidepressant prescribing

Abstract

ParticipantsGPs in 30 practices (n = 63) purposively selected to reflect a range of practice characteristics and levels of antidepressant prescribing. MethodInterviews with GPs were taped and transcribed. Analysis followed a Framework Approach. ResultsGPs offered a range of explanations for the rise in antidepressant prescribing in Scotland. Few doctors thought that the incidence of depression had increased, and many questioned the appropriateness of current levels of prescribing. A number of related factors were considered to have contributed to the increase. These included: the success of campaigns to raise awareness of depression; a willingness among patients to seek help; and the perceived safety of selective serotonin reuptake inhibitors, making it easier for GPs to manage depression in primary care. Many GPs believed that unhappiness, exacerbated by social deprivation and the breakdown of traditional social structures, was being 'medicalised' inappropriately. ConclusionMost antidepressant prescriptions in Scotland are issued by GPs, and current policy aims to reduce levels of prescribing. To meet this aim, GPs' prescribing behaviour needs to change. The findings suggest that GPs see themselves as responders to, rather than facilitators of, change and this has obvious implications for initiatives to reduce prescribing. Keywords depression; drugs; mental health; qualitative research; primary care. INTRODUCTIONLevels of antidepressant prescribing have dramatically increased in Western countries in the last two decades.1-8 The reasons for this increase are not clear, but in Scotland they are not due to an increase in the incidence or prevalence of depression, or recorded help-seeking behaviour by patients. 9 Most cases of depression in the UK are managed entirely in primary care and the vast majority of prescriptions for antidepressants are issued by GPs.10 GPs have, therefore, played a central role in the rise of antidepressant prescribing.Concern

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