title: [Management of a first depressive episode in the primary care setting. Use of antidepressants and referrals].
abstract: BACKGROUND
  The majority of patients who have a first depressive episode are treated by Primary Care physicians. The aim of this study was to evaluate the use of antidepressants and referrals to mental health and the treatment modifications made by psychiatrists.
  
  
  METHODS
  A descriptive, retrospective study was conducted on patients from 64 Primary Care clinics, distributed in five Spanish provinces. The clinical history data, regarding use of antidepressants, criteria for referral, and response of psychiatric services were evaluated from June 2008 to June 2011.
  
  
  RESULTS
  The study included 324 patients. The most commonly prescribed medication was escitalopram, with selective serotonin reuptake inhibitors (SSRI) making up 73.5% of the total. More than two-thirds (69.7%) of the patients were on treatment for at least 6 months, with no reason recorded for the 40.4% drop-outs. A large majority of professionals (76.9%) wait at least 3 weeks before modifying the medication, especially changing antidepressant. The Primary Care physicians referred 39.2% of patients to psychiatry, although much of these referrals (43.9%) had no justification. There was a lower referral rate to psychology (23.1%). An antidepressant was given to a large number of patients on multiple medications, without taking into account the risk of interactions in a high percentage.
  
  
  CONCLUSIONS
  The Primary Care physician appropriately uses the antidepressants of the first choice, but does not pay attention to the risks in complex patients. There must be an appropriate duration of treatment and an improvement of the criteria for referral to mental health services.
authors.affiliation: Medicina de Atención Primaria, Centro de Salud Alisal, Santander, Cantabria, España. Electronic address: jrlopezlanza@gmail.com.
authors.forename: J R
authors.initials: JR
authors.lastname: López-Lanza
authors.affiliation: Medicina de Atención Primaria, Centro de Salud Sardinero, Santander, Cantabria, España.
authors.forename: M
authors.initials: M
authors.lastname: Villa Puente
authors.affiliation: Medicina de Atención Primaria, Centro de Salud Alisal, Santander, Cantabria, España.
authors.forename: R
authors.initials: R
authors.lastname: Lopez Videras
authors.affiliation: Medicina de Atención Primaria, Centro de Salud Ensanche II, Pamplona, Navarra, España.
authors.forename: I
authors.initials: I
authors.lastname: Arribas
authors.affiliation: Medicina de Atención Primaria, Centro de Salud Puerta la Villa de Gijón, Gijón, Asturias, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Pandiella
authors.affiliation: Medicina de Atención Primaria, Centro de Salud Valle-Inclan, Orense, España.
authors.forename: E
authors.initials: E
authors.lastname: Sineiro
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013030:Spain; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Antidepresivos; Antidepressants; Atención primaria; Depresión; Depression; Derivación; Primary care; Referral