Abstract
The study by Hollingworth, Burgess and Whiteford is important in highlighting concerns about the appropriate management of affective and anxiety disorders in the Australian population [1].
One of the issues they raised was the poor alignment between the prevalence and self-reported treatment rates of these disorders in the community and the populations for whom antidepressant medications are being prescribed. They highlighted prescribing rates to the very elderly as a major area of discrepancy. The authors offered some explanations for this discrepancy, including the acknowledged limitations of PBS and pharmacy data which do not provide information on the conditions for which these medications are prescribed. By inference, the authors suggest that the prescribing behaviour of general practitioners (GPs) should be questioned, as antidepressant ‘prescriptions are provided by general practitioners in the community’.
The Bettering the Evaluation And Care of Health (BEACH) programme is a national cross-sectional survey of general practice activity in Australia, which is now in its thirteenth year of continual data collection [2]. The advantage of BEACH is that it collects all information about prescriptions written by a nationally representative sample of Australian GPs, including the indication for which it is written. Further, it collects details of all prescriptions, regardless of payment thresholds or safety net levels.
The management of mental health problems by GPs, including prescribing, counselling and referral rates for each indication (depression, anxiety, sleep disorders, etc.) and how these have changed over the decade between 1998–2008, the period under investigation by Hollingworth et al., has been published elsewhere and may give another perspective complementary to the findings of their study [3].
The prescribing of antidepressants in general practice has increased significantly over the past decade, in line with a significant increase in the frequency of managing depression. However, the rate at which antidepressants are prescribed for depression by GPs has not changed, i.e. the patients being managed for depression are receiving antidepressant medication at the same rate as they did ten years ago.
BEACH shows that, consistently across the past decade, about 70% of antidepressants were prescribed for depression. About 16% were prescribed for anxiety, sleep disorders and other psychological problems including schizophrenia, stress disorders, phobias, eating disorders, and sexual dysfunction. Because of their muscle relaxant and other properties, around 10% were prescribed for back and other musculoskeletal problems, neurological problems, premenstrual and menopausal problems, headache/migraine.
The GP-reported prescribed daily dose (PDD) of antidepressants for all age groups has decreased over the decade, and the average PDD for those aged 85 years or older is lower than the average for all patients [Britt H: unpublished BEACH 2000-09 data]. The PBS and pharmacy data also include scripts provided by psychiatrists and geriatricians. If doctors are over-prescribing SSRIs and other antidepressants to the very elderly, BEACH data suggest these prescriptions are not being provided by GPs.