General practitioners' perceptions of the tolerability of antidepressant drugs: a comparison of selective serotonin reuptake inhibitors and tricyclic antidepressants.
OBJECTIVE
To examine inceptions and discontinuations of antidepressants in general practice.


METHODS
An observational study analysing data from an ongoing cross sectional postal survey. Every three months a representative sample of 250 doctors recorded prescribing activity for four weeks. This provided 4000 general practitioner weeks of recording per year.


METHODS
A representative panel of general practitioners in England, Wales, and Scotland.


METHODS
Patients who began a new course of an antidepressant or had their treatment stopped or changed by the general practitioner between 1 July 1990 and 30 June 1995.


METHODS
Numbers of patients prescribed a new course of antidepressant; numbers discontinuing treatment; the ratio of antidepressant discontinuations to antidepressant inceptions; reasons for discontinuation; proportion of switches to another antidepressant.


RESULTS
There were 13,619 inceptions and 3934 discontinuations of selective serotonin reuptake inhibitors and tricyclic antidepressants during the study. The number of newly prescribed courses of antidepressants increased by 116%, mostly due to an increase in prescribing of serotonin reuptake inhibitors. The ratio of total discontinuations to inceptions was significantly lower for serotonin reuptake inhibitors (22%) than for tricyclic antidepressants (33%). Differences persisted when controlled for age and sex of patients and severity of depression. However, there was more switching away from selective serotonin reuptake inhibitors when they failed (72%) than from tricyclic antidepressants (58%).


CONCLUSIONS
Selective serotonin reuptake inhibitors are less likely than tricyclic antidepressants to be discontinued. A prospective study is needed in general practice to assess the implications of differences in discontinuation rates and switches on clinical and economic outcomes.
Martin
R M
RM
Division of General Practice and Primary Care, St George's Hospital Medical School, London.
Hilton
S R
SR
Kerry
S M
SM
Richards
N M
NM
D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data*; D006801:Humans; D008499:Medical Records; D010465:Perception; D012606:Scotland; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016312:Treatment Refusal; D014852:Wales
D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors