Differences in management of depression in Spain from psychiatric and primary care physician point of view

Abstract

Introduction. Given that depression is the most prevalent psychiatric disorder in our society, the current situation in pharmacotherapy of depression in Spain has been studied from the point of view of psychiatrists and general practitioners (GP).

Method. A total of 339 interviews were carried out with two groups of physician (238 primary care physicians and 101 psychiatrists) from different Spanish cities. Distribution, application and questionnaires collection were made throughout 2002.

Results. The diagnostic instruments most commonly used by more than 90% of both medical groups to detect a depressive disorder in a consultation are the evaluation of symptoms and the interview with the patient. However the main diagnostic problem was masking of depression with other symptoms/disorders. Most GP (95%) and psychiatrists (99%) establish a pharmacological treatment in all their depressive patients. Both groups coincide in most community use of SSRI as drugs of first choice (93% from both samples). The pharmacological agents most used by the psychiatrist are the scrotonine selective reputake inhibitors (SSRI) (98.3 %), followed by venlafaxine (84.4%), anxiolytics (68.4%), mirtazapine [58.9%) and reboxetine (55.8%). In the case of GP, the most commonly used pharmacological groups are SSRI (98.3 %) and anxicilytics (73.4 %). In primary care, the SSRI are considered the most effective antidepressant group. However, the tricyclic antidepressives (TCA) would be the most effective for the psychiatrists.

Conclusions. For psychiatrists and GP, the quality of care of depression in Spain is rated positively. However, there is a group of deficiencies and some aspects that need to be clearly improved, such as the time of consultations, coordination between GP and psychiatrists, waiting lists and available resources for mental health units.