BMJ Press Releases, Saturday 5 October 1996
Volume 313 No 7061

EMBARGOED 00.01 HRS 4 OCTOBER 1996

DEPRESSION: A SUITABLE CASE FOR TREATMENT

[Lay people's attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch]

[Prescribing antidepressants in general practice: Editorial]

[Cross sectional database analysis of antidepressant prescribing in general practice in the UK, 1993-5]

[Antidepressant drug use in primary care: a record linkage study in Tayside, Scotland]

Stigma and widespread misconception surround the treatment of depression according to a survey published in this week's BMJ. Over three quarters of the 2003 people contacted wrongly believed antidepressant drugs to be addictive and only 16 per cent thought they should be given to depressed people.

Professor Robert Priest and colleagues investigated public attitudes to the treatment of depression at the end of 1991 before the start of the Defeat Depression Campaign. Results form the baseline to assess any change in attitudes brought about by the five year campaign run jointly by the Royal College of Psychiatrists and Royal College of General Practitioners.

Counselling was the treatment favoured by most people in the general public survey. Participants thought depression was caused by adverse life events such as unemployment, a death in the family or a broken relationship. Nevertheless they saw depression as a medical illness and, despite a general reluctance to consult a doctor, most people felt a GP was the appropriate person to deal with depression initially. Half the men and women in the survey thought a GP might regard depressed people as unbalanced or neurotic (1007 people, 50 per cent ) or that the doctor would be irritated or annoyed by it (456 people, 23 per cent).

About 50 per cent of people with depression do not consult their family doctor . The Defeat Depression Campaign encourages depressed people to seek medical treatment and helps doctors recognise depression. In the sample survey, 60 per cent (1203 people) thought that people with depression would be embarrassed to consult their GP. Many of those who receive antidepressant drug treatment from their GP abandon taking the drugs prematurely.

Prescribing habits are changing, writes GP Dr Tony Kendrick in a BMJ editorial. An analysis of a large GP prescribing database (John Donoghue and colleagues, also in this week's BMJ) shows that between 1993 and 1995 the number of prescriptions for depression increased by nearly 30 per cent, mostly due to increased prescribing of the newer type of drugs called selective serotonin reuptake inhibitors (SSRIs eg Prozac) . Unlike the older tricyclic antidepressant drugs, the newer SSRIs are being prescribed at effective doses from the start of treatment. A study in the BMJ of antidepressant prescribing in Scotland (Dr T.M.MacDonald)found that tricyclic antidepressants were commonly given in doses too low to be of benefit in treating major depression. They were also given for short and probably ineffective durations. Further research is called for to find out why GPs continue to prescribe tricyclic antidepressants at low doses and to investigate the consequences. Contact:

Prof Robert Priest

Dept Psychiatry
Imperial College School Medicine at St Mary's
London

Tel: 01753 653178 or 0171 725 1648
Fax: 0171 725 1994

Dr Tony Kendrick

Gen Practice and Primary Care
St George's Hospital Medical School
London SW17 0RE

Tel :0181 725 5412
Fax: 0181 767 7697

Mr John Donoghue

Pharmacy Department
Wirral Hospital (NHS) Trust
Wirral L63 4JY

Tel: 0151 334 4000 x 4266
Fax: 0151 727 5276

Dr T.M.MacDonald
Medicines Monitoring Unit
Dept Clinical Pharmacology
University of Dundee
Dundee DD1 9SY

Tel: 01382 632 575
Fax: 01382 644 972

LEAD LEVELS DOWN

[Blood lead concentrations in UK have fallen substantially since 1984]

A large fall in blood lead concentration levels is reported in this week's BMJ in a letter from Dr Trevor Delves of Southampton University's School of Medicine. Blood samples from 6868 people - mainly adults - from eight regions in England, showed much lower blood lead concentrations than were found in environmental monitoring programmes in the mid 1980s. Increased sales of lead free petrol will have contributed to this , says Dr Delves.

Contact: Dr Trevor Delves
Consultant Biochemist

University of Southampton Medical School
Southampton SO16 6YD

Tel: 01703 796 419

FIT TO BE A DOCTOR?

[Hepatitis B and admission to medical school: an audit of British medical school policy]

Guidelines on screening prospective medical students for hepatitis B carrier status are being interpreted in differing ways by Britain's medical schools. A survey reported in this week's BMJ shows a wide range of reactions among medical schools to the question on hepatitis B screening: "Under what circumstances would you refuse a student , or remove one from your degree course?" Two medical schools said they would not remove any students. The paper comments "The setting of consistent and achievable policy on the screening of medical and dental students before entry is vital to avoid inappropriate testing, inappropriate exclusion of potential students, and inconsistencies between medical schools."

Contact: Dr Gordon Parker

Centre for Occupational Health
School of epidemiology and health sciences
University of Manchester

Tel: 0161 275 6971
Fax:0161 275 6989
E-mail: gordon.parker@man.ac.uk

PATIENT DISSATISFACTION COULD BE UNDERESTIMATED

[Can different patient satisfaction survey methods yield consistent results? Comparison of three surveys]

It's not only what you ask but the way that you ask it that affects results, according to a paper on patient satisfaction in this week's BMJ. A study comparing different questionnaire results among hospital patients in Scotland shows certain questions may have underestimated the extent of dissatisfaction because of the way they were worded. Questions about communication between doctor and patient showed the greatest differences eg was the patient encouraged to ask questions, did the doctor listen and did the patient understand what was said. "Asking patients if they agree with a negative description of their hospital experience tends to produce less apparent dissatisfaction than asking (patients) if they agree with a positive description" is a key message of the paper.

Contact: Mr Geoff Cohen

Dept Public Health Sciences
Edinburgh University Medical School
Edinburgh EH8 9AG

Tel: 0131 536 9226
0131 650 3237
Fax: 0131 650 6909

[EDITORIAL: QUALITY OF CARE THROUGH THE PATIENT'S EYES]

Patient satisfaction surveys are just the start of an emerging science, writes Professor Thomas Delbanco of Harvard Medical School in an editorial in this week's BMJ. Asking patients to report on the quality of their care may bring clinicians and patients closer together, he writes. Contact: Prof Thomas Delbanco

Beth Israel Deaconess Medical Centre
Harvard Medical School
Boston MA 02215 USA

Tel: 001 617 667 3992
Fax: 001 617 667 2854

CHRONIC FATIGUE SYNDROME

[Expert group has reached consensus on prognosis of chronic fatigues syndrome]

Dr Mansel Aylward, Chief Medical Adviser at the Department of Social Security, writes in this week's BMJ on chronic fatigue syndrome. Prognosis and duration of the illness are critical factors in determining a sufferer's entitlement to benefits or pension. The expert group set up to advise on chronic fatigue syndrome has agreed scenarios representing a good and a poor prognosis. Dr Aylward says it will bring some consensus to an area of controversy.

Contact: Dr Mansel Aylward
Chief Medical Adviser

Department Social Security
London WC2N 6HT

Tel:0171 962 8082
Fax: 0171 962 8785

EMBARGO: 00.01 HRS FRIDAY 4 OCTOBER 1996

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