Letters

GPs' perceptions of tolerability of selective serotonin reuptake inhibitors and tricyclic antidepressants

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7107.547a (Published 30 August 1997) Cite this as: BMJ 1997;315:547

Clinical assessments are liable to bias

  1. Jan Grace, Clinical research associatea
  1. a Department of Old Age Psychiatry, Newcastle General Hospital, Newcastle NE4 6BE
  2. b Statham Grove Surgery, London N16 9DP
  3. c Gwent Community Health NHS Trust, Talygarn County Hospital, Pontypool, Gwent NP4 5YA
  4. d Division of General Practice and Primary Care, St George's Hospital Medical School, London SW17 0RE
  5. e CompuFile, Send, Woking, Surrey GU23 7EF

    Editor—Richard M Martin and colleagues have provided information about the rate of discontinuation of antidepressants in general practice.1 The marked rise in new prescriptions, mainly for selective serotonin reuptake inhibitors, is noteworthy. The rise may be due to the wider range of indications for the use of selective serotonin reuptake inhibitors, though the paper focuses on a diagnosis of depression. The rise may also result from the social acceptability of these drugs and hence a much lower threshold for prescription. Prescriptions of selective serotonin reuptake inhibitors for panic disorder and obsessive-compulsive disorder, and increasingly because of patient choice, define a different population from that which is prescribed tricyclic antidepressants. Rates of discontinuation as a result of side effects will be affected by this bias in treated populations.

    Although the authors controlled for the severity of depression, the measurements used were clinical assessments and hence liable to bias. With data of this kind there is concern that a circular argument is being made: that a different scale of severity is used for those patients who are prescribed selective serotonin reuptake inhibitors than is used for those prescribed tricyclic antidepressants. In practice this would mean that severe depression treated with selective serotonin reuptake inhibitors would be less severe than severe depression treated with tricyclic antidepressants.

    References

    1. 1.

    Research into long term use is needed

    1. Naureen Bhatti, General practitioner registrarb,
    2. Jonathan Graffy, Royal College of General Practitioners research training fellowb
    1. a Department of Old Age Psychiatry, Newcastle General Hospital, Newcastle NE4 6BE
    2. b Statham Grove Surgery, London N16 9DP
    3. c Gwent Community Health NHS Trust, Talygarn County Hospital, Pontypool, Gwent NP4 5YA
    4. d Division of General Practice and Primary Care, St George's Hospital Medical School, London SW17 0RE
    5. e CompuFile, Send, Woking, Surrey GU23 7EF

      Editor—The findings of Richard M Martin and colleagues suggest that selective serotonin reuptake inhibitors are better tolerated than tricyclic antidepressants in primary care.1 Although the authors present data on the rates of discontinuation and side effects, they do not comment on how long treatment was prescribed for or on the proportion of patients …

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