An investigation of primary care patients receiving extended treatment with selective serotonin reuptake inhibitors.
OBJECTIVE
To determine the psychiatric characteristics of a sample of primary care patients receiving extended treatment with selective serotonin reuptake inhibitors (SSRIs) as well as to assess the appropriateness of extended treatment.


METHODS
A prospective case series of patients (convenience sample) assessed with survey, psychological testing, interview, and medical record review.


METHODS
Participants (n = 39) were patients in a health maintenance organization primary care setting receiving treatment with SSRI-type antidepressants for 12 months or longer, with no psychiatric evaluation or treatment immediately before commencement of antidepressant therapy. Each participant completed measures of self-destructive behavior and personality disturbance, underwent a clinical psychiatric interview, and had their medical record reviewed to determine psychiatric diagnoses by the primary care physician at the initiation of antidepressant treatment.


RESULTS
On psychiatric interview, 64.1% of participants were diagnosed with major depression, the majority recurrent (46.2% of the entire sample); 46.2% with dysthymia; and 38.5% with panic disorder. Psychiatric morbidity in this sample was reflected by recurrent depressive episodes, long-standing depression, comorbid psychiatric diagnoses on interview (average of 1.8 diagnoses per participant), self-harm behaviors, and personality pathology. Seventy-seven percent of primary care diagnoses gleaned from medical records reflected depressive diagnoses. The approximate "match" rate for a depression-spectrum diagnosis between psychiatric interviewer and primary care physicians was 90%; however, on psychiatric interview, 16.7% of participants had bipolar disorder and 38.5% had panic disorder, which were not noted in the primary care medical record.


CONCLUSIONS
Patients in primary care settings receiving extended treatment with SSRIs may have complex psychopathology for which long-term antidepressant treatment appears appropriate.
Sansone
R A
RA
Sycamore Primary Care Group, Miamisburg, OH 45342, USA.
Wiederman
M W
MW
Sansone
L A
LA
Touchet
B
B
D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D017723:Drug Utilization Review; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D008485:Medical Audit; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D010556:Personality Tests; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors