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Am J Psychiatry 1994; 151:694-700
Copyright © 1994 by American Psychiatric Association
Use of minor tranquilizers and antidepressant medications by depressed outpatients: results from the medical outcomes study
KB Wells, W Katon, B Rogers and P Camp
RAND Corporation, Santa Monica, CA 90407-2138.
OBJECTIVE: The purpose of this study was to compare use of minor
tranquilizers and antidepressant medications by depressed outpatients
across different treatment settings. METHOD: The study subjects were 634
patients with current depressive disorder or depressive symptoms who
visited general medical clinicians, psychiatrists, psychologists, or other
therapists. Data on use of medication in different types of clinical
practices with different types of payment plans were gathered from
structured interviews by study clinicians and from surveys of patients.
RESULTS: Of the depressed patients, 23% had recently used an antidepressant
medication and 30% had used a minor tranquilizer. The level of use was
similar for different types of depression. Patients of psychiatrists were
the most likely to use medications. In the practices of physicians, but not
nonphysicians, the more severely distressed patients were more likely to
use antidepressant medications. Of the patients taking an antidepressant
medication, 39% used an inappropriately low dose. Patients in prepaid
health care plans were twice as likely as those in fee-for-service care to
use minor tranquilizers. CONCLUSIONS: Less than one-third of the depressed
outpatients used antidepressant medications, and the probability of use was
similar for major depression and other types of depression for which
efficacy is less well established. Use of antidepressant medications among
patients of nonphysicians was unrelated to the level of psychological
sickness, suggesting the need for more cooperation among provider groups.
Minor tranquilizers were used more often than antidepressants, particularly
among patients in prepaid plans, despite controversy over their efficacy.
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