RCPsych AGM10 - Quality of Depression Care - Antidepressant Prescribing
International Congress of the
Royal College of Psychiatrists
21-24 June 2010, EICC, Edinburgh
Quality of Care for Individuals with Depression:
How Many People Receive Adequate Antidepressant Treatment?
Niman Gajebasia ST5 in psychiatry, Leicester Partnership Trust, Leicester Bhanu Chadalavada Consultant in general adult psychiatry,
Northampton Mental Healthcare Trust, Northampton Alex J Mitchell Consultant in Psychiatry, Department of Cancer & Molecular Medicine,
University Hospitals Leicester (UK) firstname.lastname@example.org
To review quality of antidepressant prescribing by healthcare professionals for those with established depression.
There is concern about the quality of antidepressant prescribing and aftercare given to individuals with established depression
METHODS Systematic search and critical appraisal of evidence from 1980 to June 2010.
RESULTS We located 23 studies examining antidepressant prescribing and related quality of care. 6x involved care in the
community (household surveys); 9x involved care by general practitioners, 3x involved quality of care in specialist mental health
settings and 5x involved mixed settings (3 involving a comparison)
In the community study 61% received some treatment for depression; of these, 36% received minimally adequate depression
treatment. In primary care between 21% and 69% received minimally adequate antidepressant treatment. Further about half had a
documents treatment plan and only one in ten received discussion of side effects. The quality of antidepressant treatment was
about 15% greater for persons seeing psychiatrist and 5% greater for persons seeing psychologists. In one comparative study
treatment was minimally adequate in 12.7% in the medical sector vs 46.4% in the mental health specialty sector. Thus even in
specialist mental health care settings many people with established depression are not receiving minimally adequate treatment
(Roy-Bryne et al 2009 Psychiatr Serv 60:1190-1197).
Depression Quality of Care: Antidepressants i community & mixed Depression Quality of Care: Antidepressants ii Primary care & Specialist
CONCLUSIONS Considerable deficits in quality of antidepressant treatment are evident in most settings. Between a
third and a half of depressed individuals in contact with healthcare services appear to be in receipt of predefined
minimally adequate treatment.