Réalités et recommandations dans la prescription et l'observance des antidépresseurs en médecine générale : évaluation des pratiques dans le traitement de la dépression en Lorraine et Champagne-Ardenne

Abstract

Introduction: In 2002, the French regulatory authority Anaes issued official guidelines in the pharmacological treatment of depression, which have been widely publicised within the french medical profession. The aim of the study was to evaluate the actual prescription of antidepressants (AD) in general clinical practice and assess potential deviations in reference to these guidelines and recommendations. Methods: This is a retrospective study in ambulatory patients, treated with an AD for depression by general practitioners. The cohort was composed of incident cases during 2003 in the Lorraine and Champagne-Ardenne catchment areas of the french healthcare system (URCAM). Patients had to answer a questionnaire, administred during a clinical interview by a trained physician belonging to the URCAM, in order to document the characteristics, efficacy and tolerance of the prescribed drugs as well as compliance and reasons for non compliance, according to patients' views and opinions. Results: Six hundred and thirty-two persons (71.2% women and 38.2% men, mean age: 48.6) answered the questionnaire. The incidence of depression, treated with AD, was estimated at 3.65/100 persons-years. Sixty-one percent of the patients were treated for a first depressive episode, 13% for a second and 8% for a third episode. Eighteen percent had been treated for four or more episodes. The drugs prescribed were selective serotonin reuptake inhibitors (SSRI) and serotonin-noradrenaline dopamine reuptake (SNRI) in 80.5% of the cases, tricyclics in 6.2% cases and 91.2% of the SSRI-SNRI were prescribed at adequate daily doses, according to recommendations, whereas tricyclics and other antidepressants were inadequately at low regimens. The duration of AD treatment was adequate (≥ 6 months) in 63.6% cases for tricyclics, but only 45.8% in cases for SSRI or SNRI and 39.2% for other AD. Altogether, there were adequate treatments for only 40.2% of the SSRI and the SNRI, 21.3% of other AD and only 18.8% of tricyclics. Treatment was discontinued in overall 58.1% cases on patients' initiative and this percentage reached 71.3% in the case of premature withdrawal (< 6 months). The feeling of being cured (47.6%) and occurrence of side effects (23.6%) were the main reasons mentioned by patients for discontinuing treatment. Conclusion: The discrepancies and deviations according to official guidelines demonstrate the need for continued education of professionals, for implementation of standards of practice and for large scale public opinion information, in order to durably change attitudes and behavior towards depression and its treatment. © 2008 L'Encéphale, Paris.