DRUG UTILIZATION AND PRESCRIPTION PATTERN OF ANTIDEPRESSANTS IN PSYCHIATRIC DEPARTMENT OF A TERTIARY CARE TEACHING HOSPITAL: AN OBSERVATIONAL STUDY
Main Article Content
Keywords
Drug utilization, antidepressants, prescription patterns, psychiatric care, rational prescribing, fixed-dose combinations, generic drugs
Abstract
Objective: The present observational prospective clinical-pharmacological study aimed to assess the drug utilization and prescription pattern of antidepressants in the psychiatric outpatient department at Mahatma Gandhi Medical College & Hospital, Jaipur.
Methods: The study spanned six months, and prescriptions of 100 patients were recorded including patient’s demographic details, diagnosis, drug name, dose duration and frequency. Patients’ consent was sought before data collection. Rationality of the prescriptions were assessed using WHO core prescribing indicators.
Results: The findings of the study showed that depression was more common among males and in the 21-40 years age bracket. The most frequent diagnosis was endogenous depression with mixed depressive anxiety disorder being the second most frequent. Among the antidepressants, escitalopram, which is usually co-administered with clonazepam was the most common and fluoxetine was the second most common. The use of multiple drugs was common, with three drugs being the most used and most patients were on one-month courses. A meager 9% of the drugs were prescribed by their generic name; 46% of the drugs belonged to the National List of Essential Medicines. The use of FDCs was observed in 8. 2% of the prescriptions.
Conclusion: The present study concluded that further improvements are needed in prescribing practices of antidepressants. Several problems such as low compliance with generic prescribing, insufficient utilization of essential medicines, high levels of polypharmacy and FDCs that lead to higher costs, possible side effects, and interactions stress the significance of increasing the role of rational prescribing to increase the effectiveness of treatment and decrease the costs of healthcare
References
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31. Naotaka S. Research on Asian prescription patterns (REAP): focusing on data from Japan Taiwanese journal of Psychiatry. 2014;28(2):72-95.
32. Van Marwijk HW, Bijl D, Ader HJ, de Haan M. Antidepressant prescription for depression in general practice in Neitherlands. Pharm world Sci. 2001;23:46-9.
33. Gartlehner G, Hansen RA, Morgan LC, Thaler K, Lux L, Noord VM, et al. Comparative benefits and harms of second generation antidepressants for treating major depressive disorder. An updated meta analysis. Ann intern Med. 2011;155(11):772-85.
34. National Institute for Clinical Excellence. Depression in adults: recognition and management, 2009 [internet]. NICE Clinical guideline CG90: 2009. [cited 2016 Nov 19]. Available from :https://www.nice. org.uk/guidance/cg90.
35. Bauer M, Monz BU, Montezo, Quail D, Dantchev N, et al. Prescribing pattern of antidepressants in Europe: results from the factors influencing depression endpoint research (FINDER) study 2008;23(1):66-73.
36. Bridge JA, Barbe RP, Biramaher B et al, Emergent suicidality in a clinical psychotherapy trial for adolescent depression. Am J Psychiatry 2005;162:2173-2175.
37. Keller MB, Lavori PW, Mueller TI, et al. Time to recovery, chronicity and levels of psychopathology in major depression: a 5 year prospective follow up. Arch Gen Psychiatry. 1992;49:809-816.
38. Judd LL, Akiskal HS. Delineating the longitudinal structure of depressive illness: beyond clinical subtypes and duration thresholds. Pharmacopsychiatry. 2000;33:3-7.
39. Sultana J, Italiano D, Spina E, Cricelli C, Lapi F, Pecchioli S, et al. Changes in the prescribing pattern of the antidepressant drugs in elderly patients : An Italian, nationwide, population-based study, EUR J Clin Pharmacol. 2014;70(4):469-78.
40. Barbui C, Clipriani A, Patel V, Ayuso-Mateos JL, Van Ommeren M. Efficacy of antidepressants and benzodiazepines in minor depression : systematic review and meta-analysis, BR J Psychiatry 2011;198(1): 11-16.
41. Barbui C, Esposito E, Cipriani A. Selective serotonin reuptake inhibitors and risk of suicide : a systematic review of observational studies. CMAJ 2009;180(3):291-297.
42. Furukawa T, McGuire H, Barbui C. Low dosage tricylic antidepressants for depression. Cochrane Database Syst Rev 2003;(3):CD003197.
43. Gartlehnder G, Hansen RA, Morgan LC, Thaler K, Lux LJ, Noord M et al. Second-generation antidepressants in the pharmacologic treatment of adult depression: an update of the 2007 comparative effectiveness review. AHRQ 2011. Comparative Effectiveness Review (46).
44. Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock’s synopsis of psychiatry. 11th ed. Philadelphia: Wolter Kluver; 2015. Selective serotonin reuptake inhibitors; pp.3190-205.
45. Anderson IM. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord. 2000; 58:19-36.
46. Grover S, Kumar V, Avasthi A, Kulhara P. An audit of first prescription of new patients attending a psychiatry walk-in-clinic in north India. Indian J Pharmacol. 2012;44:319-25.
47. Sachdeva P D. drug utilization studies- scope and future perspectives. IJPBR. 2010;1(1):11-17.
48. Thomas M, Alexander B, Tony S, Andrei Z. guidelines for implementing drug utilization review programs in hospitals. Russia: Management sciences for health; 1997.
49. Grover S, Avasthi A, Kalita K, Dalal PK, Rao GP, Chadda RK, et al. IPS multi-centric study: Antidepressant prescription patterns . Indian J Psychiatry. 2013;55:41-5.
50. Ambwani S, Mathur AK .Rational drug use .Health administrator Vol: XIX Number 1:5-7.
2. Depression. World Health Organization [Updated 2017 Feb 1: cited 2017 May 4]. Available from:http://www.who.int/mediacentre/fact sheets/fs369/en/.
3. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2197-223.
4. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLOS Med. 2006;3:e442.
5. Depression and other common mental disorders: global health estimates. Geneva: World Health organization; 2017 (http://apps.who.int/iris/ handle/10665/254610, accesed 25 march 2017)
6. Ray S, Chogtu B. Prescribing trends in depression: a drug utilization study done at a tertiary healthy care centre. J Clin Diagn Res 2011;5(3): 573-7.
7. Kessler RC. Epidemiology of Women and depression. J Affect Discord. 2003;74(1):5-13.
8. National Institute for Health and Clinical Excellence Depression: Treatment and Management of Depression in Adults, 2009. Available from: http://www.Guidance.Nice.org.uk/CG90 [Last accessed on 2013]
9. Ferguson JM. SSRI antidepressant medications: adverse effects and tolerability. Prime care companion. J chin Psychiatry. 2001;3(1):122-7.
10. Kessler RC, Aguilar- Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. The global burden of mental disorders: An update from the WHO World Mental Health (WMH) Surveys. Epidemiol psychiatr Soc 2009;18(1):23-33.
11. Hamid Reza Motavallyzadeh, Mohammad Reza Baneshi, Maryam Rameshk, NouzarNakhaee, et al. Prescribing pattern of antidepressant drugs among General Practiotiners and Psychiatrics: A study from Iran. Russian open Medical Journal. 2013;2(2):5-8.
12. Ghosh S, Royachaudhary S. Prescribing pattern of antidepressants drugs in a tertiary care hospital of eastern india. J Chem Pharm Res 2014;6(6):2593-7.
13. Trivedi JK, Dhyani M, Sareen H, Yadav VS, Rai SB. Antidepressant drug prescription pattern for depression at a tertiary health care centre of Northern India. Med Pract Rev. 2010;1(2):16-8.
14. Einarson T. Pharmacoepidemiology. A text book of clinical pharmacy Practice essential concepts and skills. 1st ed., Hyderabad: Universities Press (India) Limited; 2008:405-423.
15. Laporte JR, Porta M, Capella DO. Drug Utilization studies: a tool for determining the effectiveness of drug use. Brit J Pharmacol. 1983 Sep 1;16(3):301-4.
16. Chiles JA, Miller AL, Crismon ML, Rush AJ, Krasnoff AS, Shon SS. The Texas Medication AlgorithmProject: development and implementation of the schizophrenia algorithm. Psychiatric Services. 1999 Jan;50(1):69-74.
17. Hirschfeld RM, Montgomery SA, Keller MB. Social functioning in depression: a review. J Clin Psychiatry. 2000;61(4):268-75.
18. Reza MH, Reza BM, Maryam R, Nouzar N. Prescribing pattern of antidepressant drugs among general practitioners and psychiatrists: a study from Iran. Russian Open Medical Journal. 2013;2(2):205-08.
19. McManus P, Mant A, Mitchell PB, Montogmery WS, Marley J, Auland ME. Recent trends in use of antidepressants drugs in Australia, 1990-1998. Med J Aust. 2000;173(9):458-461.
20. Mohanta G, Manavalan R, Prabha KS, Prasanna M. Retrospective utilization patterns of antidepressant medications. Internet J. Third World Med. 2008;7(1):15.
21. Olfson M, Marcus SC.National trends in Outpatient Psychotherapy. Am J Psychiatry 2010;167:1456-1463.
22. World Health Organization. Introduction to Drug Utilization Research; 2003. Available from: http://www.who.int/medicines/areas/quality/ safety/efficacy/drugs[Last cited on 2013, sep. 10]
23. Mishra S, Swain T, Mohanty M. Pattern of prescription & efficacy evaluation of antidepressants in a tertiary care teaching hospital in Eastern India. Asian J Pharm Clinic Rs. 2012;5(3):112-18.
24. Laporte JR, Porta M,Capella DO. Drug utilization studies: a tool for determining the effectiveness of drug use. Brit J Clin Pharmacol. 1983 Sep 1;16(3):301-4.
25. Barnett D. National Institute for Clinical Excellence, London, Technology Appraisal Guidance [report] 2002.
26. Shaktibala D, Atif BM, Vijay K, Srihari D. Psychotropic drug utilization study in psychiatric OPD of a tertiary care teaching hospital in Dehradun, Uttarakhand. J Adv Rese Biologi Sci. 2013;5(4):386-91.
27. Mohanta G, Manavalan R, Prabha K, Prassana M. Retrospective utilization pattern of antidepressants. Internet J Third World Med. 2007;7(1):75-8.
28. Zetin M, Hoepner CT, Bjornson L. Rational antidepressant selection: applying evidence –based medicine to complex real world patients. Psychopharmacol Bull. 2006;39:38-104.
29. Zimmerman M, Posternak M, Friedman M, Attitullah N, Baymiller S, Boland R, et al. Which factors influence psychiatrists selection of antidepressants? Am J Psychiatry 2004;161:1285-9.
30. National Institute of Mental Health. Depression;2011. Available from : http://www.nimh.nih.gov. [Last cited on 2013 Sep 10 ].
31. Naotaka S. Research on Asian prescription patterns (REAP): focusing on data from Japan Taiwanese journal of Psychiatry. 2014;28(2):72-95.
32. Van Marwijk HW, Bijl D, Ader HJ, de Haan M. Antidepressant prescription for depression in general practice in Neitherlands. Pharm world Sci. 2001;23:46-9.
33. Gartlehner G, Hansen RA, Morgan LC, Thaler K, Lux L, Noord VM, et al. Comparative benefits and harms of second generation antidepressants for treating major depressive disorder. An updated meta analysis. Ann intern Med. 2011;155(11):772-85.
34. National Institute for Clinical Excellence. Depression in adults: recognition and management, 2009 [internet]. NICE Clinical guideline CG90: 2009. [cited 2016 Nov 19]. Available from :https://www.nice. org.uk/guidance/cg90.
35. Bauer M, Monz BU, Montezo, Quail D, Dantchev N, et al. Prescribing pattern of antidepressants in Europe: results from the factors influencing depression endpoint research (FINDER) study 2008;23(1):66-73.
36. Bridge JA, Barbe RP, Biramaher B et al, Emergent suicidality in a clinical psychotherapy trial for adolescent depression. Am J Psychiatry 2005;162:2173-2175.
37. Keller MB, Lavori PW, Mueller TI, et al. Time to recovery, chronicity and levels of psychopathology in major depression: a 5 year prospective follow up. Arch Gen Psychiatry. 1992;49:809-816.
38. Judd LL, Akiskal HS. Delineating the longitudinal structure of depressive illness: beyond clinical subtypes and duration thresholds. Pharmacopsychiatry. 2000;33:3-7.
39. Sultana J, Italiano D, Spina E, Cricelli C, Lapi F, Pecchioli S, et al. Changes in the prescribing pattern of the antidepressant drugs in elderly patients : An Italian, nationwide, population-based study, EUR J Clin Pharmacol. 2014;70(4):469-78.
40. Barbui C, Clipriani A, Patel V, Ayuso-Mateos JL, Van Ommeren M. Efficacy of antidepressants and benzodiazepines in minor depression : systematic review and meta-analysis, BR J Psychiatry 2011;198(1): 11-16.
41. Barbui C, Esposito E, Cipriani A. Selective serotonin reuptake inhibitors and risk of suicide : a systematic review of observational studies. CMAJ 2009;180(3):291-297.
42. Furukawa T, McGuire H, Barbui C. Low dosage tricylic antidepressants for depression. Cochrane Database Syst Rev 2003;(3):CD003197.
43. Gartlehnder G, Hansen RA, Morgan LC, Thaler K, Lux LJ, Noord M et al. Second-generation antidepressants in the pharmacologic treatment of adult depression: an update of the 2007 comparative effectiveness review. AHRQ 2011. Comparative Effectiveness Review (46).
44. Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock’s synopsis of psychiatry. 11th ed. Philadelphia: Wolter Kluver; 2015. Selective serotonin reuptake inhibitors; pp.3190-205.
45. Anderson IM. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord. 2000; 58:19-36.
46. Grover S, Kumar V, Avasthi A, Kulhara P. An audit of first prescription of new patients attending a psychiatry walk-in-clinic in north India. Indian J Pharmacol. 2012;44:319-25.
47. Sachdeva P D. drug utilization studies- scope and future perspectives. IJPBR. 2010;1(1):11-17.
48. Thomas M, Alexander B, Tony S, Andrei Z. guidelines for implementing drug utilization review programs in hospitals. Russia: Management sciences for health; 1997.
49. Grover S, Avasthi A, Kalita K, Dalal PK, Rao GP, Chadda RK, et al. IPS multi-centric study: Antidepressant prescription patterns . Indian J Psychiatry. 2013;55:41-5.
50. Ambwani S, Mathur AK .Rational drug use .Health administrator Vol: XIX Number 1:5-7.
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Feb 25, 2022
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Priyanka, Dr Anusha Vohra, & Smriti Chawla. (2022). DRUG UTILIZATION AND PRESCRIPTION PATTERN OF ANTIDEPRESSANTS IN PSYCHIATRIC DEPARTMENT OF A TERTIARY CARE TEACHING HOSPITAL: AN OBSERVATIONAL STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 29(02), 452-464. https://doi.org/10.53555/jptcp.v29i02.7159
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Author Biographies
Priyanka
PG Resident, Dept of Pharmacology, MGUMST Jaipur
Dr Anusha Vohra
Senior Professor and Hod, Dept of Pharmacology, MGUMST Jaipur
Smriti Chawla
Demonstrator, Dept of pharmacology, PGIMS Rohtak
How to Cite
Priyanka, Dr Anusha Vohra, & Smriti Chawla. (2022). DRUG UTILIZATION AND PRESCRIPTION PATTERN OF ANTIDEPRESSANTS IN PSYCHIATRIC DEPARTMENT OF A TERTIARY CARE TEACHING HOSPITAL: AN OBSERVATIONAL STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 29(02), 452-464. https://doi.org/10.53555/jptcp.v29i02.7159