European Alliance Against Depression

One of the basic assumptions concerning the actual (pharmacological) treatment of depressed patients is that the majority of patients treated for depression in the primary care area does not receive an adequate pharmacological treatment. This assumption has been proven in various studies (e.g. Montano 1994, Sartorius & Ustun 1995, Lepine et al. 1997; Katon et al. 1999, Hotopf et al. 1997, Lingam & Scott 2002).
According to results of these studies treatment is not comprehensive in terms of

type of medication (e.g. prescription of benzodiazepines or neuroleptics)
dose rates (e.g. too low to avoid side-effects)
duration of treatment (e.g. several patients withdraw from pharmacological treatment after acute symptoms of a depressive episode have disappeared or are not able to cope with side-effects)

Based on these facts the training for GPs carried out within EAAD address the need for adequate, sufficient, individualised and structured pharmacological treatment of depressive disorders. Respective elements of the trainings are e.g. information about different types of antidepressants, their mechanisms of action and systematic algorithms how and to which extent pharmacological treatment of depression should be provided by a GP.

Effects of the education of GPs about pharmacological treatment of depressive disorders are being assessed by measuring changes in GPs´ prescription behaviour concerning antidepressants and other psychoactive drugs which is being analysed on the basis of prescription rates of antidepressants, neuroleptics, anxiolytics and sedatives/hypnotics.

Methodological approach

Prescription rates of major psychoactive drug groups (antidepressants, neuroleptics, anxiolytics and sedatives/hypnotics) are being analysed in most EAAD intervention regions including comparisons with control regions. Analyses are being undertaken to identify changes in prescription rates (1) between the major psychoactive drug groups (e.g. increase of prescribed antidepressants vs. decrease of prescribed neuroleptics) and (2) between different groups of medical doctors (e.g. primary vs. secondary care doctors). The analyses of anxiolytics, neuroleptics and sedatives/hypnotics are necessary to draw conclusions in terms of treatment with inadequate substances. Differentiation by different types of medical doctors is another crucial point for the analyses. It is obvious that prescription rates of psycho-pharmaceuticals differ between GPs and psychiatrists or neurologists. Thus separate analyses for at least these two groups are necessary.

Three main indicators are possible to analyse changes in prescription behaviour. Firstly volumes of sales can be analysed for different pharmaceuticals. Secondly sales of packages and thirdly amounts of active ingredients can be analysed. Due to the amount of different compounds, package sizes and regional preferences the selection of appropriate indicators for comparisons between regions is a crucial point.

For international drug utilization studies the analysis of Defined Daily Doses (DDD) based on the Anatomical Therapeutic Chemical (ATC) classification is recommended by the WHO Regional Office for Europe. The classification of a substance in the ATC/DDD system is not a recommendation for use, nor does it imply any judgements about efficacy or relative efficacy of drugs and groups of drugs but it allows to make international comparisons. To be in line with the recommendation of the WHO Regional Office for Europe, the ATC/DDD system is being utilised for respective analyses in the EAAD framework. Therefore, a core set of ATC codes has been agreed upon by the EAAD project group.

All data concerning prescription rates collected within EAAD will at least be available for the intervention period and – if possible – for a baseline and a follow-up period. Monthly analyses or quarters are defined as minimum break-down chosen for EAAD purposes.

References

Hotopf, M., Hardy, R., Lewis, G. (1997). Discontinuation rates of SSRIs and tricyclic antidepressants: a meta-analysis and investigation of heterogeneity. Br J Psychiatry 170, 120-127.
Katon, W., Von Korff, M., Lin, E., Simon, G., Walker, E., Unutzer, J., Bush, T., Russo, J., Ludman, E. (1999). Stepped collaborative care for primary care patients with persistent symptoms of depression : a randomized trial. Arch Gen Psychiatry 56(12), 1109-1115.
Lepine, J.P., Gastpar, M., Mendlewicz, J., & Tylee, A. (1997). Depression in the community: the first pan-European study DEPRES (Depression Research in European Society). International Clinical Psychopharmacology, 12(1), 19-29.
Lingam, R. & Scott, J. (2002). Treatment non-adherence in affective disorders. Acta Psychiatr Scand 105(3), 164-72.
Montano, C. B. (1994). Recognition and treatment of depression in a primary care setting. J Clin Psychiatry 55 Suppl, 18-34; discussion 35-7.
Sartorius, N. & Ustun, T. B. (1995). Mixed anxiety and depressive disorder. Psychopathology. 28 Suppl 1, 21-5.

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Última Actualización: 21.07.2010