Do patient requests for antidepressants enhance or hinder physicians' evaluation of depression? A randomized controlled trial

Med Care. 2006 Dec;44(12):1107-13. doi: 10.1097/01.mlr.0000237202.96962.fd.


Objective: We sought to ascertain whether patients' requests for antidepressants affect visit duration or history taking by primary care physicians (PCPs) for patients with depressive symptoms and a coexisting musculoskeletal disorder and to determine whether more thorough history taking is associated with diagnostic accuracy or with provision of minimally acceptable initial care for major depression.

Design: This was a randomized trial using standardized patients (SPs). Six roles involved 2 conditions (major depression and adjustment disorder, both with coexisting musculoskeletal conditions) and 3 patient request types (brand-specific, general, or none). We conducted the study in 152 PCP offices in Northern California and Rochester, New York. Physicians were assigned randomly to see 2 SPs with depression/wrist pain or adjustment disorder/back pain.

Main outcome measures: Physician history-taking for depression and the musculoskeletal condition; depression diagnosis in the medical record; antidepressant prescriptions/samples; referral/follow-up recommendations; visit duration; and provision of minimally acceptable initial depression care.

Results: General antidepressant requests were associated with more depression history-taking (Adjusted Parameter Estimate = 0.80 more questions of 10 (95% confidence interval = 0.31-1.29, P < 0.001); brand-specific requests were marginally associated with more depression history-taking (Adjusted Parameter Estimate = 0.45, 95% confidence interval = -0.04-0.93, P = 0.07). Antidepressant medication requests were not related to musculo-skeletal question asking (P > 0.3) or visit length (P > 0.8). Depression history taking was directly associated with the likelihood of a chart diagnosis of depression and the provision of minimally acceptable initial depression care.

Conclusion: General antidepressant requests increase depression history taking, including screening for suicide. Patients' requests for medication do not appear to short-circuit history taking for depression or distract the physician's attention from coexisting musculoskeletal conditions.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adjustment Disorders / complications
  • Adjustment Disorders / diagnosis*
  • Adjustment Disorders / drug therapy
  • Age Factors
  • Antidepressive Agents / administration & dosage
  • Antidepressive Agents / therapeutic use*
  • Data Collection / methods
  • Depressive Disorder, Major / complications
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / drug therapy
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Medical History Taking
  • Musculoskeletal Diseases / complications
  • Musculoskeletal Diseases / diagnosis
  • Office Visits
  • Patient Participation*
  • Physicians, Family* / psychology
  • Practice Patterns, Physicians' / organization & administration
  • Sex Factors


  • Antidepressive Agents