Correlates of low‐dosage treatment with antidepressants by psychiatrists and general practitioners

Abstract

Low-dosage treatment with antidepressants is a rule rather than an exception. The prescribing pattern is not indiscriminate, but physicians follow an adaptive strategy and there is medical and theoretical evidence which supports their practice. Outcome research will have to be clarified in future studies as to what extent reference to such intervening variables can help to optimise individual dosage finding.

A Randomized Controlled Clinical Trial Comparing “Guideline Exposed” and “Guideline Naive” Physicians in Respect to Dosage Selection and Treatment Outcome with Doxepin in Depressive Disorders

“…Our results replicate fi ndings from other studies by showing that practitioners deviate from dosage recommendations by prescribing low dosages of antidepressants [8,9,25,19,22,23,35,38,41] . Patients with mild depression received signifi cantly lower dosages than patients who were moderately or severely ill. Physicians continued to prescribe low dosages even after having been informed about guideline recommendations.…”

Impact of the WHO depression guideline on patient care by psychiatrists: A randomized controlled trial

“…Illness severity was measured with the Clinical Global Impression (CGI) Scale, with a score of 1 for “patient is not ill at all” to a score of 7 for “patient is extremely severely ill” [22]. The symptoms and severity of depression were assessed with the “depression-symptom list,” which asks about all symptoms that are mentioned in the ICD-10 definitions for depressive disorders [20, 25]. Each item is rated from 0 (“not present”) to 4 (“very severe”).…”

Prescribing a Sedative Antidepressant for Patients at Work or on Sick Leave under Conditions of Routine Care

“…Our data suggest that the work status of patients has no signifi cant infl uence on the prescribing of mirtazapine. Working patients and patients on sick leave both get the standard dosage of about 30 mg / d. The prescription of higher dosages was dependent on the severity of illness, as is known from other studies [33] , not on the work-status.…”