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Patients' Requests for Antidepressants can Influence Physician Evaluation of Depression

Patients who initiate a general discussion about the need for antidepressant medication with their primary care physician are more //likely to be thoroughly evaluated for depression than those who make a brand-specific request 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 that patients would be screened for the existence of suicidal acts or impulses.

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

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

"Our new research extends those findings by examining the impact of patient requests on the level of history-taking carried out by the physician and by exploring the association of history-taking with diagnostic accuracy as well as provision of acceptable initial care for depressed patients," he said.

The study was conducted with 18 "standardized patients" -- actors who are specifically trained to portray patients in medical education settings. Each "patient" portrayed a role involving one of two clinical presentations: major depression accompanied by carpal tunnel syndrome or an adjustment disorder a
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