Transitions from General Practitioner to Psychiatrist Care (or vice versa) during a first antidepressant treatment episode

INTRODUCTION: The aim of this study was to investigate how frequently patients transit from general practitioner (GP) to psychiatrist care and vice versa during a first antidepressant episode and antidepressant treatment changes associated with those transitions.

METHOD: Antidepressant episodes were constructed for patients (> or =18 years) initiating SSRI use in 2000 (N=10 158). Transition in care within a first treatment episode was investigated. Changes in antidepressant treatment were compared between transiting and non-transiting patients.

RESULTS: 6.0% of patients who initiate SSRI use in GP practice transited to psychiatrist care, whereas 39.1% of those initiating use in psychiatrist care transited to GP care. Patients transiting from GP to psychiatrist care were more likely to switch to other antidepressants (RR=6.16, 95% CI: 4.90, 7.75) or to other doses (RR=4.48, 95% CI: 3.76, 5.34) than non-transiting patients. No significant differences in antidepressant treatment were found for patients transiting from psychiatric to GP care.

DISCUSSION: Approximately 9% of SSRI initiators transit in care. Transitions from GP to psychiatric care lead to antidepressant treatment changes and could potentially be used in observational studies as a disease severity indicator.