Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, CH-8037, Zurich, Switzerland.
Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
BMC Fam Pract. 2021 Dec 30;22(1):261. doi: 10.1186/s12875-021-01621-7.
GPs frequently prescribe antidepressants in mild depression. The aim of this study was to examine, how often Swiss GPs recommend antidepressants in various clinical presentations of mild depression and which factors contribute to antidepressant treatment recommendations.
We conducted an online survey among Swiss GPs with within-subject effect analysis. Alternating case vignettes described a typical female case of mild depression according to International Classification of Diseases, 10 edition criteria, with and without anxiety symptoms and sleep problems. GPs indicated for each vignette their preferred treatments (several recommendations were possible). Additionally, we assessed GP characteristics, attitudes towards depression treatments, and elements of clinical decision-making.
Altogether 178 GPs completed the survey. In the initial description of a case with mild depression, 11% (95%-CI: 7%-17%) of GPs recommended antidepressants. If anxiety symptoms were added to the same case, 29% (23%-36%) recommended antidepressants. If sleep problems were mentioned, 47% (40%-55%) recommended antidepressants, and if both sleep problems and anxiety symptoms were mentioned, 63% (56%-70%) recommended antidepressants. Several factors were independently associated with increased odds of recommending antidepressants, specifically more years of practical experience, an advanced training in psychosomatic and psychosocial medicine, self-dispensation, and a higher perceived effectiveness of antidepressants. By contrast, a higher perceived influence of patient characteristics and the use of clinical practice guidelines were associated with reduced odds of recommending antidepressants.
Consistent with depression practice guidelines, Swiss GPs rarely recommended antidepressants in mild depression if no co-indications (i.e., sleep problems and anxiety symptoms) were depicted. However, presence of sleep problems and anxiety symptoms, many years of practical experience, overestimation of antidepressants' effectiveness, self-dispensation, an advanced training in psychosomatic and psychosocial medicine, and non-use of clinical practice guidelines may independently lead to antidepressant over-prescribing.
全科医生经常在轻度抑郁中开抗抑郁药。本研究的目的是检查瑞士全科医生在轻度抑郁的各种临床表现中推荐抗抑郁药的频率，以及哪些因素促成了抗抑郁药治疗的建议。
我们对瑞士全科医生进行了在线调查，并进行了个体内效果分析。交替的病例描述了根据国际疾病分类，第 10 版标准的轻度抑郁的典型女性病例，伴有或不伴有焦虑症状和睡眠问题。每位医生为每个病例指出了他们首选的治疗方法（可以有多种建议）。此外，我们评估了医生的特征、对抑郁治疗的态度以及临床决策的要素。
共有 178 名全科医生完成了调查。在对轻度抑郁初始描述的情况下，11%（95%可信区间：7%-17%）的医生建议使用抗抑郁药。如果在同一病例中添加焦虑症状，29%（23%-36%）的医生建议使用抗抑郁药。如果提到睡眠问题，47%（40%-55%）的医生建议使用抗抑郁药，如果同时提到睡眠问题和焦虑症状，63%（56%-70%）的医生建议使用抗抑郁药。有几个因素与增加推荐使用抗抑郁药的几率有关，具体来说，是更多的实践经验、在身心医学和心理社会医学方面的高级培训、自我配药以及对抗抑郁药的更高疗效认知。相比之下，认为患者特征和使用临床实践指南的影响更大，则与推荐使用抗抑郁药的几率降低有关。
与抑郁症治疗指南一致，如果没有共同的适应症（即睡眠问题和焦虑症状），瑞士全科医生很少在轻度抑郁中推荐使用抗抑郁药。然而，存在睡眠问题和焦虑症状、多年的实践经验、对抗抑郁药疗效的过高估计、自我配药、在身心医学和心理社会医学方面的高级培训以及不使用临床实践指南，可能会独立导致抗抑郁药的过度使用。
