The preferences and rationale of family doctors in pharmacological treatment for depression

In a recent issue of European Journal of General Practice, in the article, “Relationship between antidepressant and anxiolytic/hypnotic prescribing: a mixed-methods study” by Morrison et al., a study of 63 general practitioners’ (GP) opinions about their reasons for choosing antidepressants showed that GPs preferred to choose antidepressants, particularly selective serotonin reuptake inhibitors (SSRI), in the case of anxiety and overlap of anxiety and depression, as well as in the case of other mixed mood disorders [1]. It means that the area of use of SSRIs, in the opinion of GPs, is much wider than only depression, which influences the use of traditional drugs prescribed previously in the case of other mood disorders. Morrison et al. declare that future research should continue to investigate the range of potential causes of the increase in antidepressant prescribing.

Our tailor-made questionnaire-based survey of 205 family doctors (FD) aimed to find out FDs’ attitudes to mood-related problems, their readiness, motivating factors, and problems in treatment of patients with mood disorders, as well as the existence of relevant knowledge [2], [3]. Open questions were analysed using thematic analysis. To find out preferences for medicines, the reported preferences were summarized. For analysing preferences for medicines, all statements relating to preferences were marked, and similar preferences were further coded and categorized according to their content. The statements were analysed independently by the authors in a similar way, and any ambiguities in the analyses were discussed in order to reach consensus.

In this study, the preferences and rationale of the pharmacological treatment of mood disorders including depression showed that preference of a drug was related not only to diagnosis but also to other factors depending on patient age, drug efficacy, etc.

Questions concerning preferred medications in the treatment of depression, according to brand name, and reasons for the preference revealed that the medication groups preferred by the FDs for treatment were SSRIs (69%), tricyclic antidepressants (TCA) (15%), selective noradrenalin reuptake inhibitors (SNRI) (7%), tranquillizers (5%), antipsychotics (2%), monoamine oxidase inhibitors (RIMA) (1%), noradrenergic and specific serotonergic antidepressants (NaSSA) (1%), and hypnotics in a few cases. The FDs indicated SSRIs as their first-line treatment preference not only in depression but in all mood disorders. Indication of SSRIs was dependent on diagnosis as well as on various other reasons (Table I).

Table I.  Rationale of family doctors for preference of medications.

Reasons	Medication
Efficacy
Good effect	Cipramil, Cipralex, Seroxat, Prozac, Framex
Good effect for the elderly	Amitriptylin, Saroten, Noritren
Action characteristics
Good tolerance	Cipramil, Cipralex, Seroxat, Efexor
Few side effects	Cipramil, Cipralex, Seroxat, Nycoflox, Prozac, Efexor
Good for men	Prozac, Zoloft
Fast onset of action	Cipramil, Cipralex, Seroxat, Efexor, Xanax, Coaxil, Fluancol
Short time treatment	Xanax
Ease of administration
Different pharmaceutical forms	Prozac
Small dosage	Cipralex
Small dosage for start	Seroxat
Co-morbid complaints
For panic and anxiety	Seroxat, Efexor, Coaxil
For bulimia	Prozac
For insomnia	Noritren, Xanax, Remeron
For chronic pain	Noritren, Saroten
For patient with somatic complaint, for addict	Coaxil, Remeron

The most important factors that influenced drug selection were good effect, ease of administration, presence of specific clinical symptoms, speed of effect, and presence of co-morbid psychiatric disorders. In line with these findings, we would like to add to the findings of Morrison et al. that, in addition to different mood and co-morbid psychiatric disorders, it was very important how the FDs evaluated the effect of a drug in different age groups, side effects, and mode of administration.