[Management of a first depressive episode in the primary care setting. Use of antidepressants and referrals]. / Manejo en atención primaria de un primer episodio depresivo. Uso de antidepresivos y derivaciones.

INTRODUCTION: The majority of patients who have a first depressive episode are treated by Primary Care physicians. The aim of this study was to evaluate the use of antidepressants and referrals to mental health and the treatment modifications made by psychiatrists. MATERIAL AND METHODS: A descriptive, retrospective study was conducted on patients from 64 Primary Care clinics, distributed in five Spanish provinces. The clinical history data, regarding use of antidepressants, criteria for referral, and response of psychiatric services were evaluated from June 2008 to June 2011. RESULTS: The study included 324 patients. The most commonly prescribed medication was escitalopram, with selective serotonin reuptake inhibitors (SSRI) making up 73.5% of the total. More than two-thirds (69.7%) of the patients were on treatment for at least 6 months, with no reason recorded for the 40.4% drop-outs. A large majority of professionals (76.9%) wait at least 3 weeks before modifying the medication, especially changing antidepressant. The Primary Care physicians referred 39.2% of patients to psychiatry, although much of these referrals (43.9%) had no justification. There was a lower referral rate to psychology (23.1%). An antidepressant was given to a large number of patients on multiple medications, without taking into account the risk of interactions in a high percentage. CONCLUSIONS: The Primary Care physician appropriately uses the antidepressants of the first choice, but does not pay attention to the risks in complex patients. There must be an appropriate duration of treatment and an improvement of the criteria for referral to mental health services.

Manejo en atención primaria de un primer episodio depresivo. Uso de antidepresivos y derivaciones / Management of a first depressive episode in the primary care setting. Use of antidepressants and referrals

Introducción. La mayor parte de los pacientes que comienzan con un primer episodio depresivo son tratados por médicos de atención primaria. El objetivo de este trabajo ha sido evaluar la utilización de antidepresivos y derivaciones a salud mental y las modificaciones del tratamiento que realiza el psiquiatra. Material y métodos. Analizamos de forma retrospectiva 64 cupos médicos de atención primaria, distribuidos en cinco provincias españolas. Se estudiaron los datos de la historia clínica en cuanto a utilización de antidepresivos, criterios de derivación y respuesta de atención especializada. Periodo de estudio desde junio 2008 a junio 2011. Resultados. Se incluyeron en el estudio 324 pacientes. El fármaco más prescrito fue escitalopram, siendo los ISRS el 73,5% del total. Un 69,7% de pacientes mantienen el tratamiento durante al menos 6 meses, no existiendo en un 40,4% una causa registrada del abandono. La mayoría de los profesionales espera al menos 3 semanas para modificar la medicación (76,9%), siendo la primera opción cambiar de antidepresivo. Se derivó a psiquiatría un 39,2% de los pacientes, aunque en gran parte de dichas derivaciones (43,9%) no hallamos justificación. Escasa derivación a psicología (23,1%). Gran número de pacientes polimedicados a los que se añade antidepresivo, sin tener en cuenta el riesgo de interacciones en un alto porcentaje. Conclusiones. El médico de atención primaria utiliza de manera adecuada los antidepresivos de primera elección, pero descuida los riesgos en pacientes complejos. Debemos insistir más en que la duración del tratamiento sea la adecuada y mejorar los criterios de derivación a salud mental (AU)

Introduction. The majority of patients who have a first depressive episode are treated by Primary Care physicians. The aim of this study was to evaluate the use of antidepressants and referrals to mental health and the treatment modifications made by psychiatrists. Material and methods. A descriptive, retrospective study was conducted on patients from 64 Primary Care clinics, distributed in five Spanish provinces. The clinical history data, regarding use of antidepressants, criteria for referral, and response of psychiatric services were evaluated from June 2008 to June 2011. Results. The study included 324 patients. The most commonly prescribed medication was escitalopram, with selective serotonin reuptake inhibitors (SSRI) making up 73.5% of the total. More than two-thirds (69.7%) of the patients were on treatment for at least 6 months, with no reason recorded for the 40.4% drop-outs. A large majority of professionals (76.9%) wait at least 3 weeks before modifying the medication, especially changing antidepressant. The Primary Care physicians referred 39.2% of patients to psychiatry, although much of these referrals (43.9%) had no justification. There was a lower referral rate to psychology (23.1%). An antidepressant was given to a large number of patients on multiple medications, without taking into account the risk of interactions in a high percentage. Conclusions. The Primary Care physician appropriately uses the antidepressants of the first choice, but does not pay attention to the risks in complex patients. There must be an appropriate duration of treatment and an improvement of the criteria for referral to mental health services (AU)