Management of depression in general practice- insight from NPS case studies
Aim: To provide insight into the management of depression in general practice based on responses to hypothetical case studies.
Methods: National Prescribing Service (NPS) case studies are distributed to approximately 50000 health professionals as an insert in NPS News, a bimonthly therapeutic newsletter. All case study participants receive a feedback report. Since 1998, 3 different case studies have been offered on the management of depression: female with symptoms of major depression started on an antidepressant and counselling (2000); male with depression (various co-morbidities and medications) prescribed paroxetine who returns after experiencing new symptoms and no improvement after 5 weeks' therapy (2004); and female with symptoms of mild to moderate major depression who has been taking St John’s wort for a month (2005). Questions posed varied from year to year but common quality use of medicines themes from the feedback reports were examined.
Results: The 2000, 2004 and 2005 case studies were completed by 1727, 951 and 1247 participants, respectively. In 2004 and 2005, most recognised the importance of non-drug management of depression; counselling, cognitive behavioural therapy and interpersonal therapy were commonly suggested. Selective serotonin reuptake inhibitors (74% in 2000 and 67% in 2005) were most commonly chosen as the initial antidepressant. Advice regarding drug therapy (in 2000) included common adverse drug reactions, delay in onset of action and duration of treatment (with most recommending 6-12 months). Where depression was associated with insomnia, some (32% in 2000 and 14% in 2005) also prescribed a short-term hypnotic. Upon initiation or change of therapy, the majority would schedule a follow-up visit in 1-2 weeks (2004 and 2005). In 2005, most participants recognised the insufficient and inconclusive evidence on the effectiveness of St John's wort, and its potential interactions with conventional antidepressants.
Conclusion: While hypothetical in nature, responses to case studies on depression provide insight into the management of depression in the general practice setting. This can help inform the development of future NPS programs.