Abstract
Clinical experience suggests important differences in prescriptions from general practitioners and specialists. This study investigated these differences and their determinants for antidepressant drug prescribing intentions by general practitioners and psychiatrists in France. In May 1995, a mail questionnaire was sent to a representative panel of 300 general practitioners and 100 psychiatrists from the Midi-Pyrenees area (South West France). Two types of questions were asked: the first concerned the type of antidepressants prescribed according to the characteristics of depression ('severe', with insomnia, anxiety, etc.) and the second, the factors influencing prescriptions (personal experience, adverse effects, clinical trials, cost, etc.). 151 general practitioners (51%) and 63 psychiatrists (63%) answered the questionnaire. The analysis showed large differences between the two groups of physicians. Serotoninergic antidepressants were reported to be the most common first-line drugs of choice in both groups of practitioners. General practitioners claimed to prescribe serotoninergic antidepressants more frequently than psychiatrists (74 vs 59%, p < 0.05). Psychiatrists were reported to prescribe higher dosages of antidepressants than general practitioners in 'severe' depression (109.7 vs 85.6mg daily, p < 0.001). General practitioners were reported to prescribe anxiolytic agents more frequently than psychiatrists (73 vs 54%, p < 0.05), and neuroleptic agents less frequently (1 vs 11%, p < 0.001). The factors reported to influence antidepressant prescription differed in the two groups of physicians. Postuniversity teaching, hospital specialist information and registered indication were considered more important by general practitioners than psychiatrists, who reported to be more influenced by patients' and colleagues' opinions. These results demonstrated that the differences in intention in prescribing between psychiatrists and general practitioners can be explained by a different approach to prescription since psychiatrists place more importance on human and clinical factors (patients' and colleagues' opinions) than general practitioners, who referred more to 'official' data (university, hospital and registered indications).
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