title: Why do general practitioners prescribe antidepressants to their patients? A pilot study.
abstract: BACKGROUND
  The frequency of antidepressant (ADs) prescription is high, with general practitioners (GPs) responsible for about 80% of the prescriptions. Some studies considered prescriptions meet DSM criteria, while others stress inadequate use. The importance of biological and psychosocial determinants of GP prescription behaviour remains little explored. We aimed to describe the importance of these biological and psychosocial determinants and their weight in the daily practice of GPs'.
  
  
  METHODS
  During a week chosen at random, 28 GPs collected the AD prescriptions made within the previous six months, regardless of the reason for the patient contact. Bio psychosocial and AD treatment characteristics were recorded for all patients. In a random sample of 50 patients, patient characteristics were assessed via a structured face-to-face interview with the GP.
  
  
  RESULTS
  The frequency of AD prescription was 8.90% [3.94 -17.02]. The GPs initiated 65.6% [60.1-70.8] of the prescriptions. The rate of AD prescription for non-psychiatric conditions was 18%. Patients had from 1 to 9 conditions, showing a high level of multi-morbidity. There was a strong influence of past medical history and contextual problems, such as work related problems.
  
  
  CONCLUSIONS
  AD prescription is related to complex contextual situations and multi-morbid patients. GPs use a bio psycho social approach, rather than a purely biological assessment. Awareness of these influences could improve prescription by GPs.
authors.affiliation: Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France ; Department of Family practice, Rouen University, Faculty of Medicine, 20 Bd Gambetta, Rouen 76000, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Mercier
authors.affiliation: Department of General Practice, Denis Diderot Paris 7 University, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Auger-Aubin
authors.affiliation: Department of General Practice, Tours University, Tours, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lebeau
authors.affiliation: Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schuers
authors.affiliation: Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Boulet
authors.affiliation: Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Van Royen
authors.affiliation: Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium ; Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Peremans
keywords: Antidepressants; General practitioner; Off label use; Prescription; Primary care
references.citation: BMJ. 2010 Oct 20;341:c5222
references.pmid: 20961988
references.citation: Encephale. 2005 Mar-Apr;31(2):195-206
references.pmid: 15959446
references.citation: J Clin Psychiatry. 2001;62 Suppl 11:53-8
references.pmid: 11414552
references.citation: Nicotine Tob Res. 2008 Dec;10(12):1691-715
references.pmid: 19023823
references.citation: Health Aff (Millwood). 2011 Aug;30(8):1434-42
references.pmid: 21821561
references.citation: Br J Psychiatry. 1995 Sep;167(3):324-30
references.pmid: 7496640
references.citation: J Fam Pract. 2000 Jan;49(1):68-72
references.pmid: 10678342
references.citation: BMC Fam Pract. 2006 Jan 30;7:5
references.pmid: 16445855
references.citation: Rev Epidemiol Sante Publique. 2007 Jun;55(3):222-7
references.pmid: 17524584
references.citation: Encephale. 2005 Mar-Apr;31(2):182-94
references.pmid: 15959445
references.citation: BMJ. 2009 Oct 15;339:b3999
references.pmid: 19833707
references.citation: Encephale. 2002 Sep-Oct;28(5 Pt 1):411-7
references.pmid: 12386542
references.citation: Adm Policy Ment Health. 2007 Mar;34(2):116-26
references.pmid: 16969580
references.citation: J Affect Disord. 2004 Jun;80(2-3):173-9
references.pmid: 15207930
references.citation: J Clin Pharmacol. 2012 Jan;52(1):6-17
references.pmid: 21415285
references.citation: J Clin Epidemiol. 2007 Aug;60(8):819-24
references.pmid: 17606178
references.citation: J Clin Psychiatry. 2008 Jul;69(7):1064-74
references.pmid: 18399725
references.citation: Cochrane Database Syst Rev. 2011 Aug 10;(8):CD003460
references.pmid: 21833945
references.citation: Eur Urol. 2010 May;57(5):804-14
references.pmid: 20189712
references.citation: PLoS One. 2011 Mar 29;6(3):e14784
references.pmid: 21479264
references.citation: Acta Psychiatr Scand. 2010 Feb;121(2):84-93
references.pmid: 19624573
references.citation: Arch Gen Psychiatry. 2009 Aug;66(8):848-56
references.pmid: 19652124
references.citation: Ment Health Fam Med. 2010 Mar;7(1):9-15
references.pmid: 22477918
references.citation: Am J Cardiol. 2011 Apr 1;107(7):972-9
references.pmid: 21256471
references.citation: BMC Fam Pract. 2013 May 04;14:55
references.pmid: 23641784
references.citation: J Clin Psychiatry. 2002 Sep;63(9):817-25
references.pmid: 12363124
references.citation: Am J Psychiatry. 2007 Nov 1;164(11):1764-1765
references.pmid: 22688233
references.citation: Encephale. 2010 Jun;36 Suppl 2:D48-58
references.pmid: 20513461
references.citation: Soc Sci Med. 2003 Mar;56(6):1335-44
references.pmid: 12600369
references.citation: J Affect Disord. 2008 Sep;110(1-2):84-93
references.pmid: 18329721
references.citation: BMC Fam Pract. 2011 Sep 24;12:99
references.pmid: 21943348