• Tony Kendrick, Fiona King, Louise Albertella, and Peter Wf Smith.
• Division of Community Clinical Sciences, School of Medicine, University of Southampton. ark1@soton.ac.uk
• Br J Gen Pract. 2005 Apr 1; 55 (513): 280286280-6.

BackgroundGPs are prescribing more antidepressants than previously, but not in accordance with guidelines. The reasons why they prescribe are not well understood.AimTo explore associations between GP treatment and severity of depression, patients' life difficulties, previous history of illness and treatment, and patient attitudes.DesignObservational study in two phases, 3 years apart.SettingSeven practices in Southampton, UK.MethodAdult attenders who consented were screened for depression in the waiting room. After the consultation, the 17 participating GPs completed questionnaires on the perceived presence and severity of depression, patients' life difficulties, previous problems and treatment, patient attitudes towards antidepressants, and their treatment decisions. Patients returned postal questionnaires on sociodemographics, life events, physical health, and attitudes towards antidepressants.ResultsOf 694 patients screened in the two phases, the GPs rated 101 (15%) as depressed, acknowledged depression in 44 cases (6%), and offered treatment in 27 (4%), including antidepressants in 14 (2%). Offers of antidepressants were more likely in both phases where the GPs rated the depression as moderate rather than mild, and where they perceived a positive patient attitude to antidepressants. However, GP ratings of severity did not agree well with the validated screening instrument, and their assessments of patients' attitudes to treatment were only moderately related to patients' self-reports.ConclusionsIn line with current guidelines, GPs base prescribing decisions on the perceived severity of depression, taking patients' preferences into account, but they do not accurately identify which patients are likely to benefit from treatment. Better ways to assess depression severity and patient attitudes towards antidepressants are needed in order to target treatment more appropriately.

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