The need to act versus reluctance to act: a qualitative study of primary care antidepressant prescribing for patients with common somatic conditions of uncertain cause

Leydon, Geraldine M. and Raine, Rosalind (2006) The need to act versus reluctance to act: a qualitative study of primary care antidepressant prescribing for patients with common somatic conditions of uncertain cause. Primary Care Mental Health, 4 (2), 131-142.

Abstract

Background The National Institute for Clinical Excellence recently called on doctors to exercise more caution in prescribing antidepressants. Antidepressants are used in the management of patients with common somatic conditions of uncertain cause. The factors influencing the prescribing of antidepressants to this group of patients are not fully understood.
Aim To explore general practitioners' and mental health professionals' perspectives on the use of antidepressants for patients with chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS) and chronic back pain (CBP).
Design of study A randomly selected sample of general practitioners and mental health practitioners in England were invited to participate in one of 16 focus group discussions. Clinical scenarios, including the use of antidepressants for patients with CFS, IBS and CBP, were discussed. Setting Meeting room, outside participants' work environment.
Methods Purposive sample of six groups. Each comprised 9-13 participants (49 GPs and 15 mental health practitioners). Group talk was thematically analysed to identify their views on antidepressant prescribing.
Results Two overarching and opposing themes emerged. The first was the need to act. Reasons for action included: lack of clear research evidence, desire to help patients, and a need for GPs to maintain their own self-worth. The second theme was a reluctance to act/prescribe antidepressants because of the potential for harm, their short-term effects and preference for somatic treatments for IBS and CBP.
Conclusions The perception that action is preferable to inaction poses a barrier to effective clinical practice and can lead to internal conflict between practitioners' beliefs and actions.

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Contributors

Author: Geraldine M. Leydon

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