Trend Mirrors General Practice: Psychiatry Residents May Miss TCAs, MAOIs

Article excerpt

BOSTON -- Psychiatry residents appear to be overlooking older antidepressive treatments, Dr. Rachel Dew reported in a poster at the American Psychiatric Association's Institute on Psychiatric Services.

A chart review of 112 depressed psychiatric clinic outpatients who were treated by residents showed that selective serotonin reuptake inhibitors were the most commonly prescribed antidepressants. Tricyclic antidepressants (TCAs) were used infrequently, while monamine oxidase inhibitors (MAOIs) and electroconvulsive therapy were not prescribed at all during the 12-month study period. Data suggest that this pattern parallels that of general psychiatry practice (Prog. Neuropsychopharmacol. Biol. Psychiatry 26[1]:177-87, 2002).

This pattern is in place even though TCAs and MAOIs are still included in many treatment protocols. For example, the Texas Medication Algorithm Project consensus for treatment of major depressive disorder without psychotic features places TCAs in "Stage 2" and MAOIs in "Stage 3" as alternatives after initial treatment failure, noted Dr. Dew, a child and adolescent psychiatry fellow at Wake Forest University, Winston-Salem, N.C.

Use of older antidepressants is still included in the curriculum, but if today's psychiatry residents aren't gaining expertise through use, they won't be able to train future residents in turn, she pointed out.

"There needs to be a discussion in the field as to whether older antidepressant strategies should be removed from the curriculum, or if training programs should ensure that their residents have practical experiences with them," she said in an interview with CLINICAL PSYCHIATRY NEWS.

The 112 studied patients had a mean age of 42.7 years. Two-thirds were women, and more than three-fourths were white. …