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December 18, 2001

JAMA features Group Health psychiatrist's views on choice of antidepressants

Seattle—Health plans that restrict initial antidepressant-drug coverage to the least expensive of three popular SSRI-class medications are doing the right thing, according to Gregory Simon, MD, MPH, a psychiatrist and researcher at Group Health Center for Health Studies.

In an editorial in the December 19 issue of the Journal of the American Medical Association (JAMA), Simon asserts that restrictions on first-time antidepressant prescriptions are reasonable cost-control measures—as long as patients can get the same coverage for similar drugs if the least expensive one doesn't work.

Simon's comments are based on a recent study that appears in the same issue of JAMA. Led by scientists from Indiana University—the study compared the effectiveness of the three most commonly prescribed antidepressants—fluoxetine (brand name Prozac), paroxetine (Paxil), and sertraline (Zoloft). Results showed that, on average, the three drugs worked equally well among people just starting drug treatment for depression. Still, there are many individual differences.

"The fact that these drugs are equally effective on average does not mean that they are equally effective for individual patients," wrote Simon, who has done extensive research on care for depression and other mental disorders. Also, evidence shows that it's impossible to predict which patients might do better on which particular drug. So individuals may need to try out one or more drugs before they find one that works and does not produce intolerable side effects, he said. That's why health plans need to provide equal coverage for those second- and third-choice drugs, Simon argued.

Simon also calls for doctors to provide regular follow-up care so that prescriptions can be changed or adjusted if necessary.

Simon's recommendations are consistent with Group Health's current policies related to drug coverage and care for patients who are prescribed antidepressants.

Group Health Center for Health Studies conducts epidemiologic, health-services, and clinical research related to prevention, diagnosis, and treatment of major health problems. Funded primarily through government and private research grants the Center is located in Seattle, Washington.

Group Health Cooperative is the nation's largest consumer-governed health care system, serving nearly 600,000 people in Washington and Idaho.

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