title: Prescribing ANtiDepressants Appropriately (PANDA): a cluster randomized controlled trial in primary care.
abstract: BACKGROUND
  Inappropriate use of antidepressants (AD), defined as either continuation in the absence of a proper indication or continuation despite the lack of therapeutic efficacy, applies to approximately half of all long term AD users.
  
  
  METHODS
  We have designed a cluster randomized controlled clinical trial to assess the (cost-) effectiveness of an antidepressant cessation advice in the absence of a proper indication for maintenance treatment with antidepressants in primary care.We will select all patients using antidepressants for over 9 months from 45 general practices. Patients will be diagnosed using the Composite International Diagnostic Interview (CIDI) version 3.0, extended with questions about the psychiatric history and previous treatment strategies. General practices will be randomized to either the intervention or the control group. In case of overtreatment, defined as the absence of a proper indication according to current guidelines, a cessation advice is given to the general practitioner. In the control groups no specific information is given. The primary outcome measure will be the proportion of patients that successfully discontinue their antidepressants at one-year follow-up. Secondary outcomes are dimensional measures of psychopathology and costs.
  
  
  CONCLUSIONS
  This study protocol provides a detailed overview of the design of the trial. Study results will be of importance for refining current guidelines. If the intervention is effective it can be used in managed care programs.
  
  
  BACKGROUND
  NTR2032.
authors.affiliation: Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Muskens
authors.forename: Rhona
authors.initials: R
authors.lastname: Eveleigh
authors.forename: Peter
authors.initials: P
authors.lastname: Lucassen
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.forename: Jan
authors.initials: J
authors.lastname: Spijker
authors.forename: Peter
authors.initials: P
authors.lastname: Verhaak
authors.forename: Anne
authors.initials: A
authors.lastname: Speckens
authors.forename: Richard Oude
authors.initials: RO
authors.lastname: Voshaar
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D037001:Directive Counseling / Q000191:economics*; D011307:Drug Prescriptions; D058006:General Practice; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics / Q000517:prevention & control*; D060046:Maintenance Chemotherapy / Q000191:economics; D009426:Netherlands; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D028761:Withholding Treatment
chemical_list: D000928:Antidepressive Agents