Antidepressant Prescribing Patterns in Korea: Results from the Clinical Research Center for Depression Study

Abstract

ObjectiveThis study aimed to investigate antidepressant prescribing patterns, including initial choice, switching and combining, and concomitant use of non-antidepressant agents, for depressive disorders in naturalistic clinical care settings in Korea.MethodsPatients with depressive disorder were recruited from both outpatient and inpatient settings in 18 hospitals from all over Korea. Treatment was performed in naturalistic patterns based on each clinician's decision. Data were collected on the prescription of antidepressants and concomitant agents from baseline to 12-week follow-up.ResultsSelective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed initial antidepressant (48.9%), followed by newer dual-action antidepressants (45.8%). When an SSRI was the initial antidepressant, 46.2% of patients whose medication was changed were moved to newer dual-action antidepressants, and 67.4% of combination cases were combined with newer dual-action ones. When a newer dual-action antidepressant was the initial antidepressant, 70.6% of patients whose medication was changed were moved to SSRIs, and other antidepressants including tricyclic antidepressants were most commonly added for combination treatment (50% of combination cases). During the treatment period, 20.6% of antidepressants prescribed were augmented by non-antidepressant agents, and 75.1% were used concomitantly with anxiolytics or hypnotics. The most commonly used concomitant non-antidepressant agent was quetiapine.ConclusionThe selection of antidepressants and the concomitant use of non-antidepressant agents are becoming increasingly diversified, and the results of this study reflect changes in the prescribing pattern in actual Korean practices.

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“…41,42 Despite their relative effectiveness, TCAs may not be as well tolerated as the newer SSRIs and are used much less frequently. [43][44][45] In the current study, SSRI use was associated with a somewhat larger, positive treatment effect than TCA use, although both effects were significant. Lee et al 33 noted that methylphenidate, when used for the treatment of depression, may be as effective as an SSRI in improving depressive symptomatology while also having a beneficial influence on cognitive recovery and daytime alertness.…”

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“…In this current study about 84% patients were offered treatment with an antidepressant, of which SSRIs were the most commonly prescribed (50%). This is in keeping with the results of studies done in Asia (Zhang et al, 2013;Sim et al, 2007;Bae et al, 2001), the United States (Ivanova et al, 2011) and Europe (Bauer et al, 2008). SSRIs are effective in the treatment of MDD.…”

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“…In accordance with the KMA‐MDD, patients (n = 723) were likely to receive either SSRIs or newer dual‐action antidepressants (mirtazapine, venlafaxine, bupropion) as first‐line treatment; SSRIs were prescribed slightly more frequently (49% compared with 46% for newer dual‐action antidepressants) (Bae et al ., ). Escitalopram and paroxetine accounted for 22% and 19% of SSRIs, respectively; mirtazapine and venlafaxine accounted for 27% and 17% of newer dual‐action antidepressants, respectively (Bae et al ., ).…”

“…In accordance with the KMA‐MDD, patients (n = 723) were likely to receive either SSRIs or newer dual‐action antidepressants (mirtazapine, venlafaxine, bupropion) as first‐line treatment; SSRIs were prescribed slightly more frequently (49% compared with 46% for newer dual‐action antidepressants) (Bae et al ., ). Escitalopram and paroxetine accounted for 22% and 19% of SSRIs, respectively; mirtazapine and venlafaxine accounted for 27% and 17% of newer dual‐action antidepressants, respectively (Bae et al ., ). Based on their initial antidepressant prescription, 68–71% of patients were maintained on antidepressant monotherapy up to 12 weeks, 24–26% of patients added another antidepressant to their original prescription, and 4–8% of patients switched to another antidepressant (Bae et al ., ).…”

“…Escitalopram and paroxetine accounted for 22% and 19% of SSRIs, respectively; mirtazapine and venlafaxine accounted for 27% and 17% of newer dual‐action antidepressants, respectively (Bae et al ., ). Based on their initial antidepressant prescription, 68–71% of patients were maintained on antidepressant monotherapy up to 12 weeks, 24–26% of patients added another antidepressant to their original prescription, and 4–8% of patients switched to another antidepressant (Bae et al ., ). Despite an overall mean switching time of 4±2 weeks, of those patients who switched antidepressants, 42% did so after 2 weeks of treatment, and 38% of combination therapies were initiated in the first week, which is discordant with current guidelines (Bae et al ., ).…”