Maintenance use of antidepressants in Dutch general practice: non-guideline concordant.

Ellen Piek,Willem A Nolen,Boudewijn J Kollen,Klaas Van Der Meer,Brenda W J H Penninx

doi:10.1371/journal.pone.0097463

Abstract

BackgroundThere is hardly evidence on maintenance treatment with antidepressants in primary care. Nevertheless, depression guidelines recommend maintenance treatment i.e. treatment to prevent recurrences, in patients with high risk of recurrence, and many patients use maintenance treatment with antidepressants. This study explores the characteristics of patients on maintenance treatment with antidepressants in general practice, and compares these characteristics with guideline recommendations for maintenance treatment.MethodsWe used data (baseline, two-year and four-year follow-up) of primary care respondents with remitted depressive disorder (≥6 months) from the Netherlands Study of Depression and Anxiety (n = 776). Maintenance treatment was defined as the use of an antidepressant for ≥12 months. Multilevel logistic regression was used to describe the association between sociodemographic, clinical and care characteristics and use of maintenance treatment with antidepressants.ResultsOlder patients, patients with a lower education, those using benzodiazepines or receiving psychological/psychiatric care and patients with a concurrent history of a dysthymic or anxiety disorder more often received maintenance treatment with antidepressants.LimitationsMeasurements were not made at the start of an episode, but at predetermined points in time. Diagnoses were based on interview (CIDI) data and could therefore in some cases have been different from the GP diagnosis.ConclusionsSince patients with chronic or recurrent depression do not use maintenance treatment with antidepressants more often, characteristics of patients on maintenance treatment do not fully correspond with guideline recommendations. However, patients on maintenance treatment appear to be those with more severe disorder and/or more comorbidity.

Highlights

Depression is a common condition that has a chronic or recurrent course in a significant proportion of cases [1]
Patients on maintenance treatment appear to be those with more severe disorder and/or more comorbidity
In a previous paper based on data from the Netherlands Study on Depression and Anxiety (NESDA), we reported that only 5.5% of patients receiving antidepressants in Dutch primary care, do use their antidepressant without a justified indication according to the primary care guidelines depression and anxiety [12]

Summary

Introduction

Depression is a common condition that has a chronic or recurrent course in a significant proportion of cases [1]. Most guidelines do recommend maintenance treatment, of various durations, in a subgroup of patients with high risk of recurrence. The various guidelines, such as the NICE guideline depression in adults, the ICSI Health Care guideline major depression in adults in primary care and the Dutch General practitioners guideline depression (NHG-standaard Depressieve stoornis) use different indicators for patients at increased risk of recurrence [5,7,8,9,10,11]. Almost all guidelines recommend maintenance treatment with antidepressants in case of recurrent depression, some after a first episode if it was a severe or chronic episode. Depression guidelines recommend maintenance treatment i.e. treatment to prevent recurrences, in patients with high risk of recurrence, and many patients use maintenance treatment with antidepressants. This study explores the characteristics of patients on maintenance treatment with antidepressants in general practice, and compares these characteristics with guideline recommendations for maintenance treatment

Methods

Results

Discussion

Conclusion