title: Most antidepressant use in primary care is justified; results of the Netherlands Study of Depression and Anxiety.
abstract: BACKGROUND
  Depression is a common illness, often treated in primary care. Many studies have reported undertreatment with antidepressants in primary care. Recently, some studies also reported overtreatment with antidepressants. The present study was designed to assess whether treatment with antidepressants in primary care is in accordance with current guidelines, with a special focus on overtreatment.
  
  
  METHODS
  We used baseline data of primary care respondents from the Netherlands Study of Depression and Anxiety (NESDA) (n = 1610). Seventy-nine patients with treatment in secondary care were excluded. We assessed justification for treatment with antidepressant according to the Dutch primary care guidelines for depression and for anxiety disorders. Use of antidepressants was based on drug-container inspection or, if unavailable, on self-report. Results were recalculated to the original population of primary care patients from which the participants in NESDA were selected (n = 10,677).
  
  
  RESULTS
  Of 1531 included primary care patients, 199 (13%) used an antidepressant, of whom 188 (94.5%) (possibly) justified. After recalculating these numbers to the original population (n = 10,677), we found 908 (95% CI 823 to 994) antidepressant users. Forty-nine (95% CI 20 to 78) of them (5.4%) had no current justification for an antidepressant, but 27 of them (54.5%) had a justified reason for an antidepressant at some earlier point in their life.
  
  
  CONCLUSIONS
  We found that overtreatment with antidepressants in primary care is not a frequent problem. Too long continuation of treatment seems to explain the largest proportion of overtreatment as opposed to inappropriate initiation of treatment.
authors.affiliation: Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Piek
authors.forename: Klaas
authors.initials: K
authors.lastname: van der Meer
authors.forename: Witte J G
authors.initials: WJ
authors.lastname: Hoogendijk
authors.forename: Brenda W J H
authors.initials: BW
authors.lastname: Penninx
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy*; D003863:Depression / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents