Consistency of initiation of treatment with specific serotonin reuptake inhibitors with their marketing authorisations

Aims: The principal objective of this study was to assess the consistency of initiation of treatments with selective serotonin reuptake inhibitors (SSRI) which the indications listed in their marketing authorisations (MA) in Basse-Normandie. Methods: This transverse retrospective survey involved a sample of patients between 18 and 70 years old with no past history of anti-depressant treatment during the two years before this study, to whom an SSRI was dispensed on an outpatient basis between December 1, 2003 and March 31, 2004. The data were collected from the medicines coding. Consistency with MA was assessed after the patients had undergone a clinical examination by the advisory doctor using a structured psychiatric interview, the Mini international neuropsychiatric interview (MINI). Results: Into the study, 292 patients were randomised. SSRI prescriptions were inconsistent with MA in 33.7 % [28.2 ; 39.5] of patients. Depression made up 54.7 % [48.5 ; 60.7] of diagnoses. In 22 % [17.3 ; 27.5] the patients had no psychiatric diagnosis and in 32 % [26.4 ; 38.1] the patients stopped treatment after a month whether or not the treatment was consistent with the MA. 88.8 % of prescribers [84.4 ; 92.3] were general practitioners. Conclusion: The availability of suitable medical recommendations combined with specific training programmes could improve the quality of these prescriptions. It appears necessary to promote decision making instruments in general practice for the most common psychiatric presentations and particularly, for depressive syndromes.