Drs. Laukkala and Colleagues Reply

To the Editor: We thank Drs. Patten and Beck for their interest in our article and for an opportunity to discuss our study in more detail. We found that in 1996 in Finland, of the subjects with a major depressive episode during the previous 12 months, only 13% (among the 25% with a current major depressive episode) were taking antidepressant medications. These results are comparable with those from an Australian general population study by Goldney et al. (1), in which 19% of the subjects with a current major depressive episode in 1998 were currently taking antidepressants. In a multinational European telephone survey comprising general population samples from 1993 to 1997 (2), 7% of those with current depressive disorders were currently taking antidepressants.

The unadjusted point prevalence of antidepressant use in Finland in 1996 in our study was 2.6% (158 of 5,993), information that we omitted from our article because of space limitations. This is concordant with the Finnish antidepressant reimbursement statistics for 1996 (3), which suggest a 2.3% point prevalence for antidepressant use. For comparison, the multinational European survey (2) reported point prevalences of about 1% for antidepressant use. The Canadian figures by Drs. Patten and Beck appear high to us but may be explained by a higher level of antidepressant use in Canada during the time period investigated (not specified) or by methods differences. One of these differences is that we reported current use, and Drs. Patten and Beck report use in the preceding month—a longer time period.

In our study, 44% of those taking antidepressant medication had a major depressive episode during the preceding 12 months; half (56%) of the antidepressant users took antidepressant medication without a major depressive episode during the preceding year. What proportion of these subjects was receiving antidepressants for continuation and maintenance treatment of depression and what for other possible indications remains unknown. In a survey of primary health care antidepressant use in Helsinki, Finland, in 1995 (4), about 75% of antidepressants were prescribed for depression. In the multinational European survey (2), the proportion of use for depression was even lower (44%). Since not all antidepressants are used for the treatment of depression, we do not find the calculations by Drs. Patten and Beck to be well founded.

Nevertheless, we agree with Drs. Patten and Beck on the need for improved methods in estimating need for antidepressant treatment. As the use of antidepressants is steadily rising, the pharmaco-epidemiology of their use is a moving target. In Finland, we are currently working with the data from the large Health 2000 Survey, which will provide information about antidepressant use for depressive and anxiety disorders in the country for 2000–2001.