title: Transition in care in persons with antidepressant prescription in naturalistic conditions.
abstract: BACKGROUND
  Few studies have explored transition to psychiatric care in persons treated by antidepressants in primary care.
  
  
  OBJECTIVE
  To assess the rates of transition in care after a dispensing of antidepressant and the characteristics associated with transition from primary to psychiatric care.
  
  
  METHODS
  A follow-up study of persons (n = 19 975) starting antidepressant treatment was carried out on a representative sample of the 2005-07 French Social Security Insurance national database. Prescribers were categorized as GPs, hospital practitioners (as a proxy for public psychiatrist), private psychiatrists and other private specialists. Transition in care was defined as a prescription of psychotropic drugs by a prescriber belonging to a category different from that of the index antidepressant prescriber.
  
  
  RESULTS
  Eighty per cent of incident antidepressant treatments were initiated by a GP and 28% of persons transited in care. The most frequent pattern was transition from a GP to a hospital practitioner (8%) or to a private psychiatrist (5%). Transition to psychiatric care was independently associated with younger age and markers of illness severity (psychiatric chronic illness status, duration of the index antidepressant treatment >6 months and prescription of other classes of psychotropic drugs). Almost all treatments with antipsychotics or mood stabilizers were initiated after the transition to a specialist.
  
  
  CONCLUSIONS
  Transition to psychiatric care seemed coherent with distribution of tasks between primary and secondary care according to illness severity. Further studies using detailed clinical information are required to assess not only the clinical appropriateness of psychiatric referral but also lack of referral in antidepressant users.
authors.affiliation: Université de Bordeaux, France. helene.verdoux@u-bordeaux2.fr
authors.forename: Hélène
authors.initials: H
authors.lastname: Verdoux
authors.forename: Yoan
authors.initials: Y
authors.lastname: Gaudron
authors.forename: Marie
authors.initials: M
authors.lastname: Tournier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011570:Psychiatry / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives