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Open Access Highly Accessed Research article

Understanding the prescription of antidepressants: a Qualitative study among French GPs

Alain Mercier1*, Isabelle Auger-Aubin2, Jean-Pierre Lebeau3, Paul Van Royen4 and Lieve Peremans5

Author Affiliations

1 Department of General Practice, Rouen University and CIC Inserm 0204, Rouen University, Rouen, France

2 Department of General Practice, Denis Diderot Paris 7 University, Paris, France

3 Department of General Practice, Tours University, Tours, France

4 Department of Primary and Interdisciplinary Care, Faculty of Medicine, University of Antwerp, Antwerp, Belgium

5 Department of Public Health, Vrije Universiteit of Brussels, Brussels, Belgium

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BMC Family Practice 2011, 12:99  doi:10.1186/1471-2296-12-99

Published: 24 September 2011

Abstract

Background

One-tenth of France's population is prescribed at least one antidepressant, primarily by General Practitioners. The reasons for this high prescription rate remain unclear. One-third of these prescriptions may not comply with clinical practice guidelines, and 20% are potentially unrelated to any psychiatric condition. Our aim was to explore how GPs declare they use antidepressants in daily practice and understand their reasons for prescribing them.

Method

Six focus groups including a total of 56 rural and urban GPs, with four interviews were performed. The topic guide focused on reasons for prescribing antidepressants in various primary care situations. Phenomenological analysis was performed by four researchers.

Results

Antidepressants were seen as useful and not harmful. Personal assessment based on experience and feeling determined the GPs' decisions rather than the use of scales. Twenty-four "non-psychiatric" conditions possibly leading to prescription of antidepressants in primary care were found.

Conclusions

The GPs reported prescribing antidepressants for a wide range of conditions other than depression. The GPs' decision making process is difficult and complex. They seemed to prefer to focus on their difficulties in diagnosing depression rather than on useless overtreatment. Instead of using the guidelines criteria to detect potential cases of useful prescription, physicians tend to use their own tools based on gut feelings, knowledge of the patient and contextual issues.