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July 8, 1998

Trends in Prescribing Psychotropic Medications

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(2):132-134. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-2-jac80010

To the Editor.— We are concerned about the suggestions undertreatment of depression by primary care physicians reported by Dr Pincus and colleagues,1 in their evaluation of psychotropic medication prescribing patterns of the past decade. The authors were surprised that antidepressant prescribing remained unchanged among primary care physicians after the introduction of selective serotonin reuptake inhibitors (SSRIs). While the authors attribute unchanged prescribing to delays in the diffusion of knowledge among primary care practitioners and less severe depression among primary care patients, we believe these data do not reflect the implied inappropriate management of depression by primary care physicians. The suggestion that primary care physicians are unfamiliar with SSRIs is inconsistent with recent data on medication usage. The SSRIs were 1 of the 2 most prescribed medications2 nationwide in 1996. The authors' documentation of a doubling in primary care visits for depression would suggest that more depressed primary care patients are receiving treatment, although we do not have data to analyze this effect. Lower depression severity in the primary care setting cannot be evaluated by data reported in the National Ambulatory Medical Care Survey (NAMCS). In fact, reported differences between primary care physicians and psychiatrists in identification and treatment of depression may simply reflect setting-related inconsistencies in diagnostic coding.

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