The treatment of depression: prescribing practices of primary care physicians and psychiatrists

Abstract

Background: Depression is one of the most common mental disorders treated by primary care physicians. Concern has been expressed that primary care physicians underutilize antidepressants and overutilize anxiolytics in their management of depressive disorders.

Methods: Data from the 1980, 1985, and 1989 National Ambulatory Medical Care Surveys were used to examine the pharmacologic treatment provided by primary care physicians and psychiatrists during office visits with patients diagnosed as depressed. The number and proportion of these visits that included an antidepressant prescription or an anxiolytic prescription were determined.

Results: Primary care physicians and psychiatrists both prescribed antidepressants more commonly than other classes of psychotropic medications during visits that included a depression diagnosis. Compared with psychiatrists, primary care physicians more commonly prescribed antidepressants for depressive disorders (1980, 55% vs 33%; 1985, 59% vs 41%; 1989, 57% vs 45%). In 1989, benzodiazepines were prescribed in 16% of the primary care visits for depression. More than half of these visits (56%) also resulted in an antidepressant being prescribed. Primary care visits for depression tended to be slightly longer than other primary care visits, but only about half as long as patient visits with psychiatrists.

Conclusions: The pharmacologic treatment of depression by primary care physicians may be better focused than previously assumed. Future research should examine the informal psychological treatment routinely provided by primary care physicians to patients with depressive disorders.