National Patterns in Antidepressant Treatment by Psychiatrists and General Medical Providers: Results From the National Comorbidity Survey Replication
Ramin Mojtabai, MD, PhD, MPH; and Mark Olfson, MD, MPH
J Clin Psychiatry 2008;69(7):1064-1074
© Copyright 2018 Physicians Postgraduate Press, Inc.
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Background: Primary care physicians,
rather than psychiatrists, prescribe a majority of
psychotropic medications in the United States.
However, past research has shown significant differences
in psychopharmacologic treatment practices of
these 2 groups of physicians. The objective of
this study was to compare patient characteristics
and treatment patterns of adults in the United
States treated with antidepressant medications by
psychiatrists and other medical providers.
Method: Data from the National
Comorbidity Survey Replication (February 2001-April
2003) were used to compare characteristics of
adults (aged >= 18 years) prescribed antidepressants
by psychiatrists (N = 255) or other medical
providers (N = 673). The treatment groups were also
compared with respect to presenting problem,
antidepressant type and dose, and continuity of
treatment.
Results: Approximately 1 in 10 adults
(10.5%) were treated with an antidepressant in the
past year, usually by a general medical provider (73.6%). Compared with those treated by
psychiatrists, adults treated by general medical
providers were significantly more likely to be at
least 65 years of age and to reside in a nonurban
area. By contrast, those treated by psychiatrists
were significantly more likely to be male, to
report significant distress, to present with serious
mood or anxiety symptoms, and to meet DSM-IV criteria for mood and anxiety disorders.
Individuals treated by psychiatrists typically received
higher doses of medications, were less likely to stop
the medication before 30 days, and were more
likely to continue 90 days or longer.
Conclusions: Most adults treated with
antidepressants receive the medication from
general medical providers. In comparison with
adults treated by psychiatrists, those treated by
general medical providers are less likely to meet the
criteria for mood or anxiety disorders or to
continue medication beyond the first month. Quality
improvement initiatives in general medical
settings should focus on better targeting and continuity
of antidepressant medications.