[Management of a first XXXX in the primary care setting. Use of antidepressants and referrals].

@entity1 @entity308 @entity146 @entity837 @entity750
INTRODUCTION: The majority of @entity1 who have a first @entity308 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 @entity1 from 64 Primary Care clinics, distributed in five Spanish provinces. The clinical history data, regarding use of antidepressants, criteria for referral, and response of @entity146 services were evaluated from June 2008 to June 2011. RESULTS: The study included 324 @entity1 . The most commonly prescribed medication was @entity837 , with selective @entity750 reuptake inhibitors (SSRI) making up 73.5% of the total. More than two-thirds (69.7%) of the @entity1 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 @entity1 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 @entity1 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 @entity1 . There must be an appropriate duration of treatment and an improvement of the criteria for referral to mental health services.
