Prescribing patterns of antidepressant medications for depression in a HMO

Antidepressant selection and adequacy of treatment were assessed in patients enrolled in a medium-sized, group model HMO from July 1, 1991, to July 1, 1993, who had a diagnosis of depression and who received a prescription for antidepressants during 1992. Overall, 52% of all treatments for depression were of minimum adequate dose and duration. Serotonin reuptake inhibitors had a significantly greater percentage of treatments that were of minimum adequate dose and duration (59%) than did secondary amine tricyclics (47%), tertiary amine tricyclics (44%), bupropion (37%), and trazodone (35%). Psychiatrists had a significantly greater percentage of treatments of minimum adequate dose and duration (57%) than nonpsychiatrists (47%), although the percentage of treatments with SSRIs were approximately the same (53% versus 59%, respectively). Both class of drug and treatment by a psychiatrist were associated with minimum adequate treatment.