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

Abstract

Backgroud: The paucity of information on prescribing patterns and use of antidepressants in accordance with practice guidelines necessitated this study in Nigeria. Objective: To assess the prescribing patterns of antidepressants, average cost of prescriptions and the index of rational drug prescribing (IRDP) in a Nigerian tertiary care hospital. Methods: A retrospective study which involved the assessment of 683 prescriptions and case records of patients who received antidepressants from 1 st January 2013 to 31 st December 2014 was conducted. Information on diagnosis, patients' demographics, prescribing patterns and cost of medications was obtained therefrom. Compliance to the World Health Organization (WHO) prescribing indicators and Nigerian Standard Treatment Guidelines (STG) was assessed. The IRDP for antdepressants was determined using a validated mathematical model. The statistical analysis was performed using SPSS version 20. Results: Tricyclic antidepressants (TCAs) were the most commonly prescribed drug group (61.3%), followed by selective serotonin re-uptake inhibitors (SSRIs) with a total of 38.7%. On the average, three drugs were prescribed per prescription, while 60.3% and 38.3% of the drugs were prescribed from National Essential Medicine List (NEML) and STG respectively. The IRDP was 3.96 over 5 points. The average cost of drugs per prescription was 4.2 USD. The cost of drugs in the prescriptions written according to STG was lower compared to that in prescriptions not compliant with the STG (p < .001).Conclusions: TCAs are the most commonly prescribed antidepressants due to their affordability. The generic prescribing, medicines prescribed from the NEML and in compliance with the STG were less than the WHO standard. The rational drug use is suboptimal. Better prescribing habits, affordability and use of newer antidepressants should be encouraged by the hospital management.

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

“…• The most common medicines prescribed by psychiatrists for patients with BD are typical antipsychotics either alone or in combination with mood stabilizers [174]. Tricyclic antidepressants were the most prescribed antidepressant in the majority of studies conducted in tertiary hospitals in patients with depressive symptoms, with lower costs if clinicians follow published STGs [175,176].…”

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.…”

“…This could be due to hormones that are associated with the regulation of the menstruation cycle and pregnancy affecting mood in females. These alterations in hormonal regulation cause dysregulation of the stress response, which makes them more sensitive to developing depression and often shows magni ed neuroendocrine responses to even low levels of stress 30,40,41,44 . Women play multiple roles in family and society, such as homemakers, spouses, mothers, professionals, and caregivers.…”

“…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.…”