Antidepressant Side Effects and Physician Prescribing Patterns

Abstract

We studied the following questions: (1) Do physicians preferentially prescribe antidepressants (ADs) with the least side effects (SEs) of sedation, orthostatic hypotension, and anticholinergic activity; (2) Have there been any recent changes in prescribing patterns; and (3) Do patterns differ for psychiatrists and nonpsychiatrists. Data on psychiatrist and non-psychiatrist outpatient prescribing of specific ADs were obtained from the National Prescription Audit (NPA) for 1986 and 1989. In 1986, physicians did not minimize the use of ADs with the most of these SEs. The 1989 data indicate that psychiatrists made a major change toward prescribing more low SE ADs and less ADs with the most SEs. The data for nonpsychiatrists also suggest some movement in this direction. The availability of fluoxetine and the concomitant focus on SEs may have contributed to this shift. Further investigation is needed to clarify factors that influence physicians' choices of ADs.

Antidepressant Use Over Time in a Rural Older Adult Population: The MoVIES Project

“…Potential explanations might include aging of the cohort, selective mortality, availability of newer drugs, and changes in prescribing patterns. This pattern is similar to those reported from other US populations, e.g., an older HMO‐based sample in Seattle, 4 a community population in New England, 3 and a national prescription monitoring database 2 . Women, and individuals with a greater number of depressive symptoms, were significantly more likely to take antidepressant drugs; these findings were as expected and comparable to those of previous studies 3,5 …”

“…Throughout the past 2 decades, the prescription of antidepressant drugs in the US, particularly by nonpsychiatrists, has been increasing 1–3 . During this period, many newer, nontricyclic antidepressants have been introduced, most notably the selective serotonin reuptake inhibitors (SSRIs).…”

“…SSRIs are easier to use than the tricyclics, for a variety of reasons, and are being used increasingly as first‐line antidepressants 3,4 . Prescription trends in specific clinical (e.g., primary care, psychiatric) sectors are often reported in the literature because they are monitored by regulatory agencies 2 and by the pharmaceutical industry. However, relatively few papers 3,5,6 have been published on actual usage patterns in the community at large, particularly among older people, who are the highest overall users of prescription medications 6 …”

Side effects that Cause Noncompliance to Antidepressant Medications in the Course of Outpatient Treatment

“…Sedation, orthostatic hypotension and anticholinergic side effects have been reported to be higher with TCAs than SSRIs in many studies 18,19 . These side effects are related to receptor interaction profiles of antidepressants and they may also differ within the drug groups 19 .…”

“…Sedation, orthostatic hypotension and anticholinergic side effects have been reported to be higher with TCAs than SSRIs in many studies 18,19 . These side effects are related to receptor interaction profiles of antidepressants and they may also differ within the drug groups 19 . In a meta-analysis of 11 studies with a total of 601 patients, dry mouth, constipation, diarrhea, drowsiness, lethargy, dizziness, anorexia, tremor and sweating were more common with TCAs while nausea/vomiting and sleep disorders were reported more frequently with SSRIs.…”