A qualitative study exploring how GPs decide to prescribe antidepressants.
BACKGROUND
To influence GPs' prescribing policies and practices it is necessary to have an understanding of how they make decisions. The limited evidence available suggests that not only do GPs find making decisions about diagnosing and prescribing for depression problematic, but that decisions are severely constrained by lack of resources. As a result, it might be thought that GPs, in line with current guidelines, will inevitably prescribe antidepressants for patients presenting with symptoms of anxiety and depression. This study examines the accuracy of this view.


OBJECTIVE
To explore how GPs decide to prescribe antidepressants.


METHODS
Focus groups with self-selected GPs.


METHODS
Bristol and the surrounding district.


METHODS
Qualitative study of five focus groups with 27 GPs.


RESULTS
GPs' decisions about whether an antidepressant would be an appropriate form of management are shaped by a set of rules based on 'clinical' and 'social' criteria. The preferred strategy is to 'wait and see', but antidepressants are prescribed earlier when symptoms are perceived to be persistent, unresolving, severe and 'classic'. Decisions to prescribe are also shaped by organisational constraints of time, lack of accessible alternative management options, cost of prescribing and perceived patient attitude.


CONCLUSIONS
The evidence from this study provides little support for the view that GPs take the easy option of prescribing antidepressants in the face of uncertainty. Evidence suggests that the GPs' prescribing was cautious, which indicates that GPs would support the initiative of recent draft guidelines regarding watchful waiting. This guidance, however, needs to be clear about what constitutes mild depression and address the question of prescribing to patients who are experiencing social adversity. Furthermore, alternatives to antidepressants such as counselling would need to be readily and equitably accessible. In addition, GPs need to be convinced that alternatives to antidepressants are at least as effective for patients with so-called 'mild depression'.
Hyde
Julia
J
Institute of Psychiatry, King's College London. J.Hyde@iop.kcl.ac.uk
Calnan
Michael
M
Prior
Lindsay
L
Lewis
Glyn
G
Kessler
David
D
Sharp
Deborah
D
D000928:Antidepressive Agents / Q000627:therapeutic use*; D003657:Decision Making; D003866:Depressive Disorder / Q000188:drug therapy*; D011307:Drug Prescriptions; D004739:England; D005194:Family Practice / Q000592:standards*; D006801:Humans; D010821:Physicians, Family / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*
D000928:Antidepressive Agents