Which patients receive antidepressants? A 'real world' telephone study

Introduction: The use of antidepressants has been questioned with respect to both undertreatment and inadequate prescription. The present investigation was therefore launched to assess the psychopathology profiles of antidepressant users. Methods: A representative sample was constituted on the basis of usual antidepressant consumption, and ICD 10 compatible diagnoses were obtained after telephone administration of a structured psychiatric interview. Results: The most often used drugs were fluoxetine, followed by tricyclic antidepressants. Coprescription existed in slightly less than two thirds of antidepressant users. ICD 10 diagnoses were compared to currently available prescription guidelines. Fluoxetine prescription, as compared to other drugs, was found to be significantly more compliant with these guidelines; conversely, in 22% of antidepressant users, no complete ICD 10 diagnosis could be documented. These results are discussed in the light of report accuracy and anecdotal or 'heterodox' indications of antidepressants. Conclusion: Altogether, the present study confirms previous doubts regarding appropriate use of antidepressants and stresses the need for more explicit and comprehensive clinical guidelines. It does not substantiate, however, any evidence for a 'recreational' use of these products. (C) 1998 Elsevier Science B.V.