Evaluation for Prescribing Patterns of Newer Antidepressants in a Medical Center

• Main Authors: Ya-Chen Lo, 羅雅貞
• Other Authors: Yen-Kuang Yang
• Format: Others
• Language: zh-TW
• Published: 2003
• Online Access: http://ndltd.ncl.edu.tw/handle/96769437531005256147

碩士 === 國立成功大學 === 臨床藥學研究所 === 91 === The World Health Organization estimates that currently, major depression is the forth most important cause worldwide of loss in disability-adjusted life-years and will be the second most important cause by 2020. A frequent complication of depression is suicide. In 2002, suicide was the ninth leading cause of death in Taiwan. The uses of the newer antidepressants, selective serotonin reuptake inhibitor (SSRI) and serotonin norepinephrine reuptake inhibitor (SNRI) have been increasing since their introduction in the late 1980s and are effective in treating depressive disorder. Although just as efficacious as the tricyclic antidepressants (TCA), the newer antidepressants are associated with a more tolerable side-effects profile, leading to easier use for both the provider and the patient. Dose and duration are two important factors in achieving the goals of antidepressant treatment. They affect not only symptoms resolution, but also restoration of patients’ functioning and prevention of relapse or recurrent episodes. The aim of the present study was to evaluate the prescribing patterns of newer antidepressants, SSRIs and SNRI (venlafaxine), by patients’ age, sex, clinical diagnosis, dosage and duration of treatment. The patterns of newer antidepressants use were compared between psychiatric and non-psychiatric clinics. This study evaluated the possibility of drug interaction when newer antidepressants were used concomitantly with other medications. Data were derived from the Department of Informatics, College of Medicine, National Cheng-Kung University. The study included all outpatient users of newer antidepressants in the National Cheng-Kung University Hospital from July 1, 2001 to June 30, 2002. There were 2,477 patients representing 11,536 prescriptions. Fluoxetine and sertraline are the most used newer antidepressants (29.45 % vs. 34.13 % of prescriptions, respectively). The ages of nonpsychiatric patients are greater than psychiatric patients (55 ±17 vs. 42 ± 17 years, respectively, p < 0.001). In both the psychiatric and non-psychiatric clinics, patients took over 90 % of the doctor’s prescribing dosage. The prescribing dosages of fluoxetine, fluovoxamine, and sertraline in psychiatry are higher than those in non-psychiatry (p< 0.001, < 0.05, < 0.05). The prescribing dosages of fluoxetine, paroxetine, and sertraline for obsessive-compulsive disorder (OCD) are higher than those in other disorders. The OCD patients take longer duration of medicine as compared with other disorders (p < 0.01). The prescribing dosages of all the newer antidepressants are within the lower range of recommended dose in each disorder. Although the treatment guideline recommended 4 to 6 months for maintenance of treatment, 49.32 % of patients take newer antidepressants longer than 4 months, and 38.53 % longer than 6 months. The duration of patients in psychiatric outpatient clinics is similar to those in nonpsychiatric O.P.D (p= 0.708). Nevertheless, the compliance of psychiatric patients is even superior. The percentage of potential drug interaction is high. The SNRI has much less drug interaction than SSRIs. Both the dose and duration for depressive treatment were not sufficient compared with the recommended regimen, which may lead to the treatment failure and early relapse or recurrence.