Dick Bijl

Antidepressant prescription for depression in general practice in The Netherlands.

Objective: To evaluate diagnoses and the prescription of antidepressants drugs for depression, based on data from 1993 to 1998 related to consultations for depression in general practice in the Netherlands. Method: An exploratory analysis of data provided by IMS Health. Consecutive annual representative samples of 640 GPs regularly registered data on morbidity and (drug) treatment for specific medical problems in special booklets for a period of one week. The data refer to consultations for depression. The diagnoses were initially based on ICD‐9 criteria and later ICD‐10 criteria for depression.Main outcome measures: Number of diagnoses of depression and number of prescriptions for antidepressants.Results: The number of first consultations for depression rose gradually, from 909 in 1993 (95% CI: 774 to 1043), to 1,482 (CI: 1292 to 1672) in 1998: an increase of 63%. For an individual GP, this represents an increase from 18 to 30 in first consultations for depression. The number of prescriptions for antidepressants also increased, mainly during repeat consultations: a 278% increase, from 3,708 in 1993 to 14,024 in 1998 (CIs: 3,504 to 3,912 and 13,252 to 14,796). Antidepressants were prescribed during the first consultation 564 times in 1993 compared with 1,080 times in 1998. The first contact with a GP for depression led to an antidepressant prescription in 62% of cases in 1993 and 73% in 1998. Although the guidelines issued by the Dutch College of General Practitioners in 1994 recommended tricyclic antidepressants (TCAs) for the treatment of depression, paroxetin, fluoxetin, and mirtazapin (SSRIs) accounted for 56% of the prescribed antidepressants.Conclusion:Between 1993 and 1998, GPs in the Netherlands prescribed increasingly more antidepressants, and they prescribed more SSRIs than TCAs. Furthermore, GPs diagnose depression more frequently and the number of repeat consultations has increased.

Effectiveness of disease management programmes for recognition, diagnosis and treatment of depression in primary care.

Objectives: Screening is advocated to improve the recognition of patients with major depression in primary care. Furthermore, disease management programmes are advocated to improve the quality of care and outcome for these patients. But is screening and the subsequent implementation of a disease management programme more effective than usual care? Methods: Review of the literature on the effects of disease management programmes that include screening for major depression in general practice. Results: Six randomised controlled trials were identified in which the effectiveness of disease management programmes were studied in patients with major depression in primary care and compared with usual care. The majority of these, and especially the largest, showed positive effects on the recognition, diagnosis, treatment and outcome of patients. Populations in the US seem to benefit most. Conclusion: The results of disease management programmes for depression in primary care that include screening are positive and are more effective than usual care. Therefore, if preceded by screening, attention to the whole process of care for patients with major depression instead of paying attention to isolated elements of the process is justified.

Test-characteristics of the GDS-15 in screening for major depression in elderly patients in general practice

Abstract The aim of this study was to assess whether a cut-off of five on the 15-item version of the Geriatric Depression Scale (GDS)that was determined beforehand yielded the best sensitivity and specificity for the diagnosis of major depression in the elderly in primary care. A sample of 330 patients was drawn from a group of elderly patients (⩽ 55 years) that participated in a clinical trial, the West-Friesland Study (WFS). The mood-module of the PRIMary care Evaluation of Mental Disorder (PRIME-MD)served as the external criterion for major depression. The results showed that using a ROC-curve the best cut-off score of the GDS-15was five. This cut-off score gave a sensitivity of 0.79 and a specificity of 0.67 and a negative predictive value of 0.94. It is concluded that the validation in retrospect of the a priori chosen cut-off score of five in a sample of the study population supports our a priori choice.

Marketing beïnvloedt huisartsen te veel Exit TCA’s?

SamenvattingDe farmaceutische industrie biedt huisartsen verborgen verleiders aan.1 Packard introduceerde deze term al in 1958 om de invloed van reclame te beschrijven.2 De laatste jaren is de farmaceutische industrie sterk in beeldvorming en de introductie van deze verborgen verleiders. De beeldvorming rond antidepressiva is daar een voorbeeld van.

Amitriptyline in vergelijking met andere medicamenteuze behandelingen voor depressie

SamenvattingAchtergrond Amitriptyline werd lang beschouwd als een van de standaardmiddelen voor de medicamenteuze behandeling van depressie. Van middelen die daarna op de markt werden gebracht is vaak geclaimd dat de balans van werkzaamheid en bijwerkingen gunstiger is dan die van amitriptyline.