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June 21, 1995

Cost-effective Treatment of Depression

Author Affiliations

Canoga Park, Calif

JAMA. 1995;273(23):1833-1834. doi:10.1001/jama.1995.03520470041021

To the Editor.  —As a family physician participant in the Medical Outcomes Study (MOS), I would advise Drs Sturm and Wells1 not to extrapolate 1986 data on the use of psychotropic medications by generalist clinicians to 1994. In 1986,I wasn't using antidepressants that often, but I've come to use them frequently and, I believe, appropriately. I'm sure other general medical clinicians have changed their prescribing habits as well. Newer medications and increased continuing medical education offerings have combined to increase our familiarity with and use of antidepressants.I reviewed the chart of a depressed patient participant in the MOS. In 1986, this patient was receiving alprazolam as her only drug. Now she is receiving therapeutic doses of two antidepressants, trazodone and fluoxetine, in addition to a reduced dose of alprazolam. If I saw a similar patient today, I would prescribe antidepressants alone. This is probably true of other general medical

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