National patterns in antidepressant treatment by psychiatrists and general medical providers: results from the national comorbidity survey replication.
BACKGROUND
Primary care physicians, rather than psychiatrists, prescribe a majority of psychotropic medications in the United States. However, past research has shown significant differences in psychopharmacologic treatment practices of these 2 groups of physicians. The objective of this study was to compare patient characteristics and treatment patterns of adults in the United States treated with antidepressant medications by psychiatrists and other medical providers.


METHODS
Data from the National Comorbidity Survey Replication (February 2001-April 2003) were used to compare characteristics of adults (aged >/= 18 years) prescribed antidepressants by psychiatrists (N = 255) or other medical providers (N = 673). The treatment groups were also compared with respect to presenting problem, antidepressant type and dose, and continuity of treatment.


RESULTS
Approximately 1 in 10 adults (10.5%) were treated with an antidepressant in the past year, usually by a general medical provider (73.6%). Compared with those treated by psychiatrists, adults treated by general medical providers were significantly more likely to be at least 65 years of age and to reside in a nonurban area. By contrast, those treated by psychiatrists were significantly more likely to be male, to report significant distress, to present with serious mood or anxiety symptoms, and to meet DSM-IV criteria for mood and anxiety disorders. Individuals treated by psychiatrists typically received higher doses of medications, were less likely to stop the medication before 30 days, and were more likely to continue 90 days or longer.


CONCLUSIONS
Most adults treated with anti-depressants receive the medication from general medical providers. In comparison with adults treated by psychiatrists, those treated by general medical providers are less likely to meet the criteria for mood or anxiety disorders or to continue medication beyond the first month. Quality improvement initiatives in general medical settings should focus on better targeting and continuity of antidepressant medications.
Mojtabai
Ramin
R
Department of Psychiatry, Beth Israel Medical Center, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY 10003, USA. rm322@columbia.edu
Olfson
Mark
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004334:Drug Administration Schedule; D004358:Drug Therapy / Q000706:statistics & numerical data*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000379:methods* / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000928:Antidepressive Agents