'A coal face option': GPs' perspectives on the rise in antidepressant prescribing.

Background: Levels of antidepressant prescribing have dramatically increased in Western countries in the last two decades.

Aim: To explore GPs' views about, and explanations for, the increase in antidepressant prescribing in Scotland between 1995 and 2004.

Design: Qualitative, interview study.

Setting: General practices, Scotland.

Participants: GPs in 30 practices (n = 63) purposively selected to reflect a range of practice characteristics and levels of antidepressant prescribing.

Method: Interviews with GPs were taped and transcribed. Analysis followed a Framework Approach.

Results: GPs offered a range of explanations for the rise in antidepressant prescribing in Scotland. Few doctors thought that the incidence of depression had increased, and many questioned the appropriateness of current levels of prescribing. A number of related factors were considered to have contributed to the increase. These included: the success of campaigns to raise awareness of depression; a willingness among patients to seek help; and the perceived safety of selective serotonin reuptake inhibitors, making it easier for GPs to manage depression in primary care. Many GPs believed that unhappiness, exacerbated by social deprivation and the breakdown of traditional social structures, was being 'medicalised' inappropriately.

Conclusion: Most antidepressant prescriptions in Scotland are issued by GPs, and current policy aims to reduce levels of prescribing. To meet this aim, GPs' prescribing behaviour needs to change. The findings suggest that GPs see themselves as responders to, rather than facilitators of, change and this has obvious implications for initiatives to reduce prescribing.