The management of depression: An international naturalistic survey.

Objective. To investigate the management of major depression by primary care physicians (GP) and psychiatrists (PSY) in a naturalistic setting. Methods. GP and PSY from six countries replied to questions on the basis of the records of patients under treatment for depression. Results. Patients seen by GP and PSY were similar. Approximately 60% of patients had been treated for less than a year and about 20% for over 2 years. Continuous depressed mood and loss of interest or pleasure were present in about 75% of patients at diagnosis. Close to 60% of patients were treated with SSRIs and 15% with SNRIs. Most patients were also prescribed an anxiolytic, hypnotic or sedative. Although this was more common in patients with associated anxiety, 60% of patients with no anxiety at diagnosis were also prescribed anxiolytics by PSY (30% by GP). Most anxiolytic prescriptions were maintained throughout the depressive episode. Although the number of patients achieving full remission was only about 15%, changes in antidepressant medication during the depressive episode were rare. Conclusion. This naturalistic survey shows that in everyday practice in a number of countries adherence to guidelines for the treatment of depression is poor for both GP and PSY.