Antidepressant drug use in primary care: a record linkage study in Tayside, Scotland: Table 1

Depression is a common psychiatric disorder in general practice.'There is consensus that antidepressants should be given in sufficient dose and for sufficiently long if treatment is to be effective.2Tricyclic antidepressants carry warnings about their use in patients with cardiac diseases, and they have well known anticholiner- gic effects that could cause predictable toxicity.Selective serotonin uptake inhibitors are thought to be devoid of such effects.We studied the use and safety of antidepressant drugs in the community, with reference to their labelled warnings. Patients, methods, and resultsWe studied patient specific dispensed prescribing' for antidepressant drugs and admissions to hospital for possible adverse effects over 14 months using a record linkage database that covers the population of Tayside, Scotland (about 400 000 subjects).4The dose and duration of use of antidepressants was determined, as was the number of subjects who had labelled contrain- dications to and cautions against taking tricyclic anti- depressants.Overall, 20 195 patients received 85 315 prescriptions for an antidepressant drug (14 988 patients received tricyclic antidepressants, 3571 received selective serotonin reuptake inhibitors, and 1636 received both).In comparison with published guidelines,2 tricycic antidepressants were generally given in subtherapeutic doses (10 804 (72%) subjects received only subtherapeutic doses, 1125 (7%) therapeutic or both doses, and 3059 (21%) unknown doses).Selective serotonin reuptake inhibitors tended to be given in therapeutic doses (281 (8%) received