What evidence is there that general practitioners follow guidelines on the use of antidepressants to treat depression and how can this be improved?

Despite the availability of guidelines regarding the dosage and length of treatment with antidepressants for a depressive episode, it has been shown repeatedly that general practitioners do not always prescribe according to the guidelines. Several papers written between 1996 and the present demonstrate this fact. The implication is that patients in primary care in the UK do not receive treatment for an adequate time span and often at too low a dose, especially if older antidepressants are used. This can lead to a higher likelihood of recurrence of depressive symptoms and higher consequent morbidity. The solution we propose is the development of joint doctor-practice nurse clinics for the treatment of depression, as part of the Quality and Outcomes Framework (QOF) program. The outcomes of these clinics should be auditable against the guidelines. This, when linked with easy access to advice and referral to secondary care psychiatry specialists, argues for a collaborative care, or shared care, program for the treatment of depression in primary care.