How do clinicians choose antidepressants?

Research suggests no difference in efficacy be tween tricyclic and related antidepressant drugs. The British National Formulary (1993) lists 21 different antidepressants. Reviews of antidepres sant treatment suggest that choice of antidepres sant should be made on the grounds of previous drug exposure and side effect profiles of different drugs. At present there are no clinical guidelines to indicate which antidepressant should be pre scribed in particular clinical situations, and no evidence to suggest differences in subgroups of depressives in their response to antidepressants. Study of the rate of fatality in overdose has led Beaumont (1989) to advocate limiting the use of the older tricyclic drugs. Clinical experience sug gests that psychiatrists adopt a varied approach to treatment, and it has been argued (Joyce & Paykel, 1989) that treatment with antidepres sants is often inappropriate or inadequate, or both. This study describes the antidepressant pre scribing practice of a group of Bristol psychia trists, and examines the reasons given by clinicians for their choice of antidepressant, and their attitudes to involving patients in choosing between alternative treatments.