OBJECTIVES: Because prescribing in routine clinical practice
reflects both the physicians’ perception of the efficacy and safety
of a drug and the patient’s characteristics, this study aimed at
comparing the real-life profile of patients prescribed escitalopram,
SSRIs or venlafaxine in primary care in order to better
understand drugs-related determinants of prescription.
METHODS: This retrospective study used data from the General
Practitioners Research Database and included adult patients with
an incident prescription (no antidepressant in the previous12-
month) of escitalopram, an SSRI or venlafaxine between January
1, 2003 and June 30, 2005, and an associated diagnosis of
depression. Demographics, disease and treatment characteristics,
and health care resource consumption were assessed in the
12-month before the new prescription and compared across
treatment groups. RESULTS: A total of 6,910 patients were
prescribed escitalopram, 47,853 SSRIs and 2,832 venlafaxine.
Compared with SSRIs-treated patients, escitalopram-treated
patients were younger (p = 0.001), more often diagnosed with
severe depression (p = 0.018), and more often suffering from
associated anxiety (p < 0.001). They also had more hospitalisations (p = 0.021), referrals (p = 0.020), anxiolytics (p < 0.001) and hypnotics (p < 0.001) prescriptions at baseline. Compared with venlafaxine-treated patients, escitalopram-treated patients were younger (p < 0.001), less often diagnosed with severe depression (p < 0.001) and concomitant anxiety (p < 0.001), and had lighter psychiatric history (p = 0.002). However, they were more often suffering from cardio-respiratory diseases (p = 0.02). Baseline resource use was sensibly similar between treatment groups. CONCLUSIONS: Important differences in patients' pro- files were observed between escitalopram, generic SSRIs and venlafaxine, and correspond to current data on the drugs' effi- cacy and safety profile: physicians prescribed escitalopram and venlafaxine to patients with more severe depression. The subsequent choice between escitalopram and venlafaxine was based on safety profiles, escitalopram being perceived as safer and being prescribed to patients with a heavier somatic background. These differences have to be adjusted for in further real-life drug effectiveness studies otherwise they can importantly bias the results.