REVIEW – July 2005

Treatment of depression in primary care in Estonia


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Depression is among most frequent chronic psychiatric disorders in primary care. Most patients with depression have experienced more than one depressive episode in their lifetime. Effective pharmacological treatments for depression have been available for more than 40 years. The aim of the study was to study the preferences and rationale of family doctors (FD) in pharmacological treatment of depression and to examine the antidepressant prescribing patterns of psychiatrists and FDs. FDs indicated selective serotonin reuptake inhibitors (SSRI) as their first-line treatment preference. The most common factors that influenced antidepressant selection were the effect, ease of administration, presence of specific clinical symptoms, presence of co-morbid psychiatric disorders and price of medicaments. Sixty-five percent of antidepressant prescriptions made in primary care management were initiated by FDs. SSRIs were the FDs’ most frequent initial choice of antidepressant (76.8%) followed by tricyclic antidepressants (TCAs) (19%). FDs prescribed more SRRIs than psychiatrists, and psychiatrists prescribed other antidepressants more frequently compared with FDs. FDs and psychiatrists prescribed similar antidepressants for treatment of depression.

The most commonly used medication prescribed by FDs and psychiatrists was fluoxetine. Estonian FDs treat depression according to internationally accepted guidelines and their prescribing patterns are similar to those of psychiatrists, which demonstrates the FDs’ good knowledge of depression treatment.