Choice of antidepressants: questionnaire survey of psychiatrists and general practitioners in two areas of Sweden.
OBJECTIVE
To identify factors that affect physicians' choice of specific antidepressant drugs in order to evaluate the validity of epidemiological studies of the risks (particularly suicide) and benefits of different compounds.


METHODS
Questionnaire survey of 264 psychiatrists and general practitioners in an urban area and a rural area of Sweden with validation of data by independent prescription surveys.


METHODS
Urban area of greater Stockholm and rural county of Jämtland, Sweden.


METHODS
228 physicians (86%) who answered the questionnaire.


METHODS
The drugs used as first line drugs of choice, as drugs of choice in particularly severe depression, and as drugs of choice for disorders other than depression.


RESULTS
Amitriptyline was the most common first line drug of choice among both psychiatrists and general practitioners. The patterns of choice of antidepressants in the two areas accorded with prescribing patterns in two independent prescription surveys. Amitriptyline was chosen even more frequently for severe depression and depression with severe insomnia. Clomipramine was chosen comparatively more often for depression with severe anxiety. Low toxicity compounds (mainly lofepramine, mianserin, and moclobemide) were more often the drug of choice in depression associated with overt risk of suicide. Amitriptyline and clomipramine were used extensively for disorders other than depression (40% and 54% of prescriptions, compared with 13-19% for some other major antidepressants).


CONCLUSIONS
Patient groups treated with different antidepressant compounds may not be comparable with respect to diagnoses and severity of disease. In particular, lofepramine, mianserin, and moclobemide, and possibly amitriptyline, seem to be chosen more often for patients prone to suicide.
Isacsson
G
G
Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Huddinge University Hospital, Sweden.
Redfors
I
I
Wasserman
D
D
Bergman
U
U
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D003863:Depression / Q000188:drug therapy; D004363:Drug Utilization; D005194:Family Practice; D006801:Humans; D011570:Psychiatry; D012307:Risk Factors; D012423:Rural Health; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy; D013548:Sweden; D014504:Urban Health; D000092864:Suicide Prevention
D000928:Antidepressive Agents