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Patients who initiate⁽¹⁾ a general discussion about the need for antidepressant medication⁽²⁾ with their primary care physician⁽³⁾ are more likely to⁽⁴⁾ be thoroughly⁽⁵⁾ evaluated for depression⁽⁶⁾ than those who make a brand-specific request⁽⁷⁾ or no request, according to a new study in the December issue of Medical Care.

The study also found that general requests for antidepressants increased the likelihood⁽⁸⁾ that patients would be screened for⁽⁹⁾ the existence of suicidal acts or impulses⁽¹⁰⁾.

The research was led by an investigator⁽¹¹⁾ at the University of California, San Francisco (UCSF) in collaboration with⁽¹²⁾ researchers from the University of California, Davis and the University of Rochester.

In a previous study, the first controlled investigation of its kind⁽¹³⁾, the research team had examined the clinical behavior⁽¹⁴⁾ of physicians faced with⁽¹⁵⁾ a patient request for antidepressant treatment. From this earlier⁽¹⁶⁾ study and others, the scientists found that patients’ requests had a profound⁽¹⁷⁾ effect on physician prescribing habits⁽¹⁸⁾ regarding both major depression⁽¹⁹⁾ and the psychological condition⁽²⁰⁾ known as adjustment disorder⁽²¹⁾, which involves depression and anxiety⁽²²⁾ in response to⁽²³⁾ pain or a major event⁽²⁴⁾, such as illness or divorce⁽²⁵⁾, according to lead author⁽²⁶⁾ Mitchell Feldman, MD, MPhil, professor of medicine at UCSF, and an internist⁽²⁷⁾ at UCSF Medical Center.

“Our new research extends those findings⁽²⁸⁾ by examining the impact of patient requests on the level of history-taking⁽²⁹⁾ carried out⁽³⁰⁾ by the physician and by exploring the association of history-taking with diagnostic accuracy⁽³¹⁾ as well as provision of⁽³²⁾ acceptable initial care⁽³³⁾ for depressed patients⁽³⁴⁾,” he said.

The study was conducted with 18 “standardized patients⁽³⁵⁾” - actors who are specifically trained to portray⁽³⁶⁾ patients in medical education settings⁽³⁷⁾. Each “patient” portrayed a role involving⁽³⁸⁾ one of two clinical presentations⁽³⁹⁾: major depression accompanied by carpal tunnel syndrome⁽⁴⁰⁾ or an adjustment disorder accompanied by low back pain⁽⁴¹⁾. The standardized patients were also trained to request an anti-depressant medication by brand name, or request a general anti-depressant, or not ask for medication.