Factors affecting prescribing of the newer antidepressants

OBJECTIVE: To survey various prescriber types and specialties to determine whether differences exist in prescribing patterns for the newer antidepressants. DESIGN, SETTING, AND PARTICIPANTS: A survey about prescribing of the newer antidepressants was mailed to 1,500 New York state licensed prescribers who were randomly selected from membership rosters. Nurse practitioners; physician assistants and physicians in family medicine, primary care, general practice, and internal medicine; and psychiatrists were included. MAIN OUTCOME MEASURES: Prescriber responses regarding factors involved with choosing among the newer antidepressants. RESULTS: A total of 508 surveys (36%) were returned, of which 398 (29%) were acceptable for analysis. In choosing among the newer antidepressants, most prescribers ranked patient diagnosis and past success as a high priority, and free drug samples and drug-representative detailing as a low priority. The majority of each prescriber type preferred fluoxetine for major depression and depression associated with fatigue; paroxetine for concomitant anxiety and depression, as well as for panic disorder; and sertraline for geriatric patients and patients with suicidal ideation. Differences existed between the prescriber groups when asked whether prescribing habits for the newer antidepressants were based on familiarity with a particular agent (p = 0.0009) and on labeled indications (p = 0.002). CONCLUSIONS: This is the first study to demonstrate prescribing preferences for the newer antidepressants among different prescriber groups. Additional studies are needed to determine predictors of patient response to newer antidepressants and clinical guidelines for their use.

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