Antidepressant Prescribing Patterns for Depressive and Anxiety Disorders in a Singapore Hospital

Abstract

Objective: Although antidepressants are the recommended first-line pharmacological treatments for depressive and anxiety disorders, their prescribing patterns have not been studied in Singapore. We investigate antidepressant prescription patterns for outpatients with depressive and anxiety disorders in a general hospital in Singapore. We hypothesize that intolerance to side effects and lack of efficacy may contribute to medication switching, and that initiation of antidepressant therapy is not easily tolerated. Methods: A retrospective review of the casenotes of outpatients was carried out between January 2013 and December 2013. A total of 206 patients were randomly selected. The study was approved by the hospital's institutional review board. Data analysis was carried out using SPSS version 18. Results: There were more females than males (ratio 1.7:1) with a mean age of 50.6 ± 15.2 years. Depressive disorder, comprising 50% of the sample, was the most frequent diagnosis followed by anxiety disorder (27.2%), mixed anxiety-depression (16%) and adjustment disorder (5.8%). Almost all patients (97.1%) were prescribed antidepressants, the most common being selective serotonin reuptake inhibitors (SSRI) (75.5%), followed by the noradrenaline and specific serotonin antidepressant (NaSSA) (13.5%) and tricyclic antidepressants (TCA) (8.5%). Patients prescribed SSRIs tended to be younger and better educated (p = 0.0005). More than half of the patients (52.1%) required antidepressant switching mainly due to lack of efficacy and intolerance of side effects. Combination therapy was prescribed for 17% of patients with SSRI-NaSSA, the most preferred combination. Nearly a quarter (23.8%) patients required augmentation therapy with atypical antipsychotics. Combination (p = 0.024) and augmentation (p = 0.033) were utilized more often for depression than for anxiety disorders. Conclusion: Antidepressant medications are commonly prescribed for depression and anxiety disorders. The main reasons for switching antidepressants were intolerance and lack of efficacy. That about half of the patients reported side effects necessitating medication change confirmed our hypothesis that an-*

Drug utilization patterns of antidepressants in Federal Neuro-Psychiatric Hospital Lagos, Nigeria

“…This would enhance rational prescribing and affordability. In contrast to the findings of this study, SSRIs were the most frequently prescribed drugs in studies carried out in Asia, Europe, North America and India [3,14,15,21,[31][32][33][34] with decreased use of TCAs. Factors such as differences in culture, practice, promotional activity [32,35,36] and national income [37] contribute to these regional differences.…”

“…This is similar to the findings of other researchers. [3,21,22] This occurrence is hypothesized to be due to hormonal influence, the effect of child birth and different psychosocial stress among women. [23] Contrary to the view that SSRIs are preferred over older classes of antidepressants owing to less severe adverse effects, TCAs accounted for 61.3% of antidepressants used in the hospital under study; with SSRIs as only (38.7%).…”

Patterns of Antidepressant Prescriptions for the Treatment of Depression: A Scoping Review

“…We identi ed fteen studies through this review, and the majority of the patients were in the economically productive age group of 40-50 years [25][26][27][28][29][30][31][32][34][35][36][37][38][39] , whereas in the result of a study on antidepressant use in Italy, the mean age of the patients who received antidepressant prescriptions was more than 50 years 33 .…”

“…Our review showed that the majority of the patients receiving antidepressants for the treatment of their depression were females 27,[30][31][32][33][34][35][36][37][38][39][40][41][42][43] . This could be due to hormones that are associated with the regulation of the menstruation cycle and pregnancy affecting mood in females.…”

“…Sedentary lifestyle, lack of physical exercise, lack of hobby, irregular dietary habits, smoking, and taking alcoholic beverages or substance use are also interconnected with depression 26,32,37 . Continuous arguments, stressful daily routines, unsupportive spouses, continuous discouragement, lack of family time or husbands or wives going to other countries for employment, and ignorance from family members may be the reason for more married, housewives, and lower-income people being vulnerable to depression 26,27,30,31,33,37,38,47 . One study 48 showed that a spouse's weekly working hours are greatly associated with the partner's risk of developing depression and suicidal thoughts.…”