Patterns of antidepressant use in community practice

Simon, Gregory E.; VonKorff, Michael; Wagner, Edward H.; Barlow, William E.

doi:10.1016/0163-8343(93)90009-d

Cited by 254 publications

(126 citation statements)

References 15 publications

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“…Still, the percentage of treatment dropouts in our study resembles that in other large prospective trials of treatment interventions for major depression in primary care settings. 9,10 Although our study monitored NT serum levels to individualize medication doses and assess medication adherence, we lacked objective physical data, such as pulse and weight changes, to correlate with our study patients' subjective symptoms. Also, information regarding subjects' previous experience with tricyclic antidepressants was not collected.…”

Section: Discussionmentioning

confidence: 99%

Symptoms of Major Depression and Tricyclic Side Effects in Primary Care Patients

1997

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OBJECTIVE:To examine the prevalence and course of symptoms resembling side effects of tricyclic antidepressants among primary care patients experiencing major depression and receiving nortriptyline pharmacotherapy. DESIGN:Prospective cohort study. PATIENTS: Seventy-five patients meeting DSM-III-R criteria for a current major depression.SETTING: Four Pittsburgh (Pa.) ambulatory health centers affiliated with residency programs. MEASUREMENTS AND MAIN RESULTS:Symptoms resembling tricyclic side effects were assessed at baseline and at monthly intervals using the Somatic Symptoms Checklist. The Hamilton Rating Scale for Depression and Diagnostic Interview Schedule were used to assess depressive severity and history of generalized anxiety or panic disorder, respectively. Symptoms resembling tricyclic side effects, including thirst (54%), palpitations (51%), and dry mouth (48%), were commonly experienced before commencing pharmacotherapy. Patients with severe depressive episodes and those with a history of an anxiety or panic disorder had significantly more physical symptoms than those with milder episodes of depression and were more likely to drop out of care ( n ‫؍‬ 25) before completing the acute phase of pharmacotherapy. Patients who completed the acute phase of pharmacotherapy and those who entered its continuation phase ( n ‫؍‬ 43) experienced significant reductions in many depressive and physical symptoms ( p Ͻ .001). CONCLUSIONS:Symptoms resembling tricyclic side effects are common among depressed primary care patients before beginning pharmacotherapy and generally remit with the depressive episode. Better awareness of major depression's somatic effects and the consequences of therapy could result in better management of both physicians' and patents' expectations regarding antidepressant pharmacotherapy. ajor depression is experienced by 6% to 8% of primary care patients, 1 and is associated with significant psychic distress and functional disability. 2-5 A metaanalysis of randomized clinical trials by the Depression Guideline Panel of the Agency For Health Care Policy and Research concluded, however, that most episodes of this disorder can be resolved efficaciously when antidepressant medications are prescribed at proper dosages and for adequate durations. 6 Thus, it is of concern that primary care physicians often prescribe these drugs at dosages too low to achieve therapeutic benefits and for periods too brief to prevent relapse. [7][8][9][10][11] The rationale guiding prescribing practices of primary care physicians has been the subject of much speculation. One possibility for why antidepressant medications, particularly of the tricyclic type, are prescribed at subtherapeutic dosages is that they produce disturbing side effects for patients who already are highly sensitive to the psychological and somatic symptoms associated with their depressive illness. Medication-induced discomforts such as thirst, dry mouth, palpitations, and dizziness, which are most marked early in the course of treatment, could lead ...

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Section: Discussionmentioning

confidence: 99%

Symptoms of Major Depression and Tricyclic Side Effects in Primary Care Patients

1997

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“…2,3 Rates of successful completion of appropriate treatment, however, are low. 4,5 Research shows that collaboration between PC clinicians and mental health (MH) specialists is necessary if better outcomes are to be achieved. [6][7][8][9][10][11] We describe the process used to institutionalize ongoing MH/PC collaboration across 7 Department of Veterans Affairs (VA) outpatient clinics in 5 states as part of a depression quality-improvement project, the Translating Initiatives for Depression into Effective Solutions (TIDES) project.…”

mentioning

confidence: 99%

Developing Effective Collaboration Between Primary Care and Mental Health Providers

Felker¹,

Chaney²,

Rubenstein³

et al. 2006

Prim. Care Companion CNS Disord.

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“…Shared aims go beyond more money for services, and include developing services that are more effective. The success of several interventions in psychiatry is limited because of a reluctance of some patients to engage with treatment (Simon et al, 1993); and those who do not engage may have the greatest needs (Killaspy et al, 2000). Service users are ideally placed to contribute to the development of more acceptable services and need to inform research into new forms of service delivery.…”

Section: Shared Aims?mentioning

confidence: 99%

Involving users in the development of psychiatric services – no longer an option

Crawford¹

2001

Psychiatr. bull.

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Patterns of antidepressant use in community practice

Cited by 254 publications

References 15 publications

Symptoms of Major Depression and Tricyclic Side Effects in Primary Care Patients

Symptoms of Major Depression and Tricyclic Side Effects in Primary Care Patients

Developing Effective Collaboration Between Primary Care and Mental Health Providers

Involving users in the development of psychiatric services – no longer an option

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