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Continuity and monitoring of antidepressant therapy in a primary care setting

BackgroundLittle is currently known about the continuity and monitoring of antidepressant treatment at individual patient level in primary care. AimsTo assess continuity of antidepressant therapy in a UK primary care setting at the individual patient level and whether this therapy is conducted with appropriate review. MethodsA systematic analysis was undertaken in two general practices in Aberdeen, Scotland of primary care records of adults initiated on an antidepressant for a new episode of depression or anxiety within a 12-month period and followed up for three years. Demographic and clinical details were recorded. Uni- and multivariate analyses were performed. ResultsThe sample consisted of 191 patients. Median duration of treatment for the first episode was 180 (inter-quartile range (IQR)=60, 429) days, with 29% of patients receiving an antidepressant for 60 days or less. Age and previous receipt of antidepressants contributed significantly to predicting treatment duration (p0.01); effect size (R2=0.1). The median interval between antidepressant review consultations increased progressively with increasing treatment duration. There were no significant predictors of frequency of antidepressant review. ConclusionDepression management could be improved by assertive review (and better characterisation) of patients who discontinue early; and by scheduled reassessment of treatment in the second and subsequent years of continuation therapy.


David J Middleton, Isobel M Cameron, Ian C Reid

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