Depression in general practice. Underrecognition? Overtreatment? Adequate care!

PhD ceremony: Ms. E. Piek, 14.30 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Depression in general practice. Underrecognition? Overtreatment? Adequate care!

Promotor(s): prof. K. van der Meer, prof. W.A. Nolen

Faculty: Medical Sciences

The results presented in this thesis give an optimistic picture of the current care for depressed patients in primary care as compared to previous literature and media reports. We conclude that, in general, the care for depressed patients in primary care is mostly adequate, i.e., in accordance with ruling guideline recommendations.

The general practitioners (GPs) recognized over two-thirds of depressed patients. Patients who discuss psychological problems with their GPs, those with more depressive symptoms and with a concurrent anxiety disorder, were better recognized. Patients presenting with the atypical symptom increased appetite were less recognized. 58% of depressed patients were referred to psychological or psychiatric care. In making referrals, GPs took guideline recommendations into account; patients with preference for psychotherapy, chronic depression or suicidal tendency were referred more often. Antidepressants were also prescribed according to guideline recommendations. Only 5.4% of the patients taking antidepressants were classified in terms of overtreatment. Furthermore, more than half of these patients started antidepressants for a good reason, but were treated too long, according to guideline recommendations. From a literature review we conclude that guideline recommendations for antidepressant treatment are thoroughly based in evidence for acute treatment and relapse prevention during several months, but not for maintenance treatment. Recommendations for maintenance treatment are also less often followed. Patients taking antidepressants for maintenance are not, as the guideline prescribes, patients with chronic or recurrent depression. It does seem, however, that maintenance antidepressant users are those with a worse prognosis such as patients with comorbid dysthymia or anxiety, and patients also receiving sedatives or patients with recent psychiatric contacts.