Determinants of Coprescription of Anxiolytics with Antidepressants in General Practice

• Published in: Canadian journal of psychiatry 2008-02, Vol.53 (2), p.94-103
• Main Authors: Verger, Pierre, Saliba, Bérengère, Rouillon, Frédéric, Kovess-Masféty, Viviane, Villani, Patrick, Bouvenot, Gilles, Lovell, Anne
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Anti-Anxiety Agents - therapeutic use; Antidepressive Agents - therapeutic use; Biological and medical sciences; Catchment Area (Health); Children & youth; Clinical trials; Depression; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - epidemiology; Drug Prescriptions - statistics & numerical data; Drug Therapy, Combination; Female; France - epidemiology; Humanities and Social Sciences; Humans; Male; Medical sciences; Mental depression; Middle Aged; Mood disorders; Neuropharmacology; Pharmacology. Drug treatments; Primary Health Care - methods; Primary Health Care - statistics & numerical data; Psychiatry; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Referral and Consultation - statistics & numerical data; Suicides & suicide attempts; Surveys and Questionnaires
• ISSN: 0706-7437; 1497-0015
• DOI: 10.1177/070674370805300204

Objectives: Anxiolytics are the most frequently prescribed psychotropic drugs in France. General practitioners (GPs) tend to prescribe anxiolytics and other benzodiazepines to patients with major depressive disorders (MDD). However, the extent to and reasons for which they prescribe these medications together are not well documented. This article assesses how often and why GPs coprescribe an anxiolytic when starting patients on antidepressant (AD) treatment, and which patient- and GP-related factors are associated with this coprescription. Methods: We used a survey of 131 GPs practising in southeastern France and of patients seen consecutively during June to October 2004 to whom they prescribed an AD. Data were collected from GPs (consultation-questionnaires focusing on their prescription, diagnosis, and symptom detection) and patients (self-administered questionnaires, including the Hospital Anxiety and Depression scale, and social and demographic characteristics). Factors associated with anxiolytic coprescription were analyzed with a multilevel logistic regression. Results: GPs completed 438 consultation-questionnaires for patients; 258 patients (58.9%) returned their questionnaires. Sixty percent of the patients received anxiolytics with ADs. Anxiolytics were prescribed more frequently by male GPs who reported feeling ill at ease treating MDD, or detected suicidal ideation or anxiety in their patients, and finally to patients with stable jobs. Conclusions: Although some practice guidelines and authors acknowledge that there might be some justification for zcoprescribing anxiolytics with ADs at the beginning of MDD treatment in specific situations, the high percentage of coprescriptions for anxiolytics observed in our study suggests that training and knowledge of GPs about MDD treatment are not optimal.