title: 'A coal face option': GPs' perspectives on the rise in antidepressant prescribing.
abstract: BACKGROUND
  Levels of antidepressant prescribing have dramatically increased in Western countries in the last two decades.
  
  
  OBJECTIVE
  To explore GPs' views about, and explanations for, the increase in antidepressant prescribing in Scotland between 1995 and 2004.
  
  
  METHODS
  Qualitative, interview study.
  
  
  METHODS
  General practices, Scotland.
  
  
  METHODS
  GPs in 30 practices (n = 63) purposively selected to reflect a range of practice characteristics and levels of antidepressant prescribing.
  
  
  METHODS
  Interviews with GPs were taped and transcribed. Analysis followed a Framework Approach.
  
  
  RESULTS
  GPs offered a range of explanations for the rise in antidepressant prescribing in Scotland. Few doctors thought that the incidence of depression had increased, and many questioned the appropriateness of current levels of prescribing. A number of related factors were considered to have contributed to the increase. These included: the success of campaigns to raise awareness of depression; a willingness among patients to seek help; and the perceived safety of selective serotonin reuptake inhibitors, making it easier for GPs to manage depression in primary care. Many GPs believed that unhappiness, exacerbated by social deprivation and the breakdown of traditional social structures, was being 'medicalised' inappropriately.
  
  
  CONCLUSIONS
  Most antidepressant prescriptions in Scotland are issued by GPs, and current policy aims to reduce levels of prescribing. To meet this aim, GPs' prescribing behaviour needs to change. The findings suggest that GPs see themselves as responders to, rather than facilitators of, change and this has obvious implications for initiatives to reduce prescribing.
authors.affiliation: Section of General Practice and Primary Care, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow G129LX, UK. s.macdonald@clinmed.gla.ac.uk
authors.forename: Sara
authors.initials: S
authors.lastname: Macdonald
authors.forename: Jill
authors.initials: J
authors.lastname: Morrison
authors.forename: Margaret
authors.initials: M
authors.lastname: Maxwell
authors.forename: Rosalia
authors.initials: R
authors.lastname: Munoz-Arroyo
authors.forename: Andrew
authors.initials: A
authors.lastname: Power
authors.forename: Michael
authors.initials: M
authors.lastname: Smith
authors.forename: Matt
authors.initials: M
authors.lastname: Sutton
authors.forename: Philip
authors.initials: P
authors.lastname: Wilson
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003657:Decision Making; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D012606:Scotland / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors