Academic journal article East Asian Archives of Psychiatry

Antidepressant Prescription Pattern in the Presence of Medical Co-Morbidity: REAP-AD 2013 Study

Academic journal article East Asian Archives of Psychiatry

Antidepressant Prescription Pattern in the Presence of Medical Co-Morbidity: REAP-AD 2013 Study

Article excerpt

Introduction

Depression is a common mental disorder and reported to have a high level of morbidity. Over the years research has confirmed the high prevalence rate of depression in patients with various medical illnesses. This high co-morbidity is now increasingly identified as a clinical and global health care issue. (1) Presence of depression in medically ill patients is associated with a high level of disease burden, morbidity, mortality, poor medication and treatment compliance, higher health care costs, poor quality of life, as well as higher level of impairment. (1,2) Accordingly adequate treatment of depression in medically ill patients is of paramount importance to improve treatment outcome of the primary medical illness.

Unfortunately, most drug trials that evaluate the efficacy and tolerability of antidepressants exclude patients with co-morbid medical illnesses. Although some recent studies have specifically evaluated the efficacy of certain antidepressants in the management of patients with various medical illnesses, (3-6) most of them have been small. Due to the lack of adequate data from well-controlled trials, treatment guidelines often recommend avoidance of certain medications or reduced doses of antidepressants in the presence of certain medical illnesses. In general, the dictum is to start with the lower dose and use lower doses of antidepressants in the presence of medical illness. Further, the selection of medication is, more often than not, guided by tolerability profile and possible drug interactions.

Nonetheless there are a lack of data with respect to the real clinical use of antidepressants in patients with medical illnesses. Only few studies have evaluated the psychotropic prescription pattern in patients with medical illnesses, and that too in the hands of non-psychiatrists in hospitalised medically ill patients with co-morbid depression (7) or elderly patients resident in long-term care facilities. (8) Many studies have evaluated the antidepressant prescription patterns of psychiatrists and other health care professionals in the management of depression and other psychiatric disorders. (9-15) Little is known about antidepressant prescription patterns of psychiatrists when a mentally ill patient has co-morbid medical illness. Therefore, this study attempted to examine the antidepressant prescription pattern in patients with various medical co-morbidities.

Methods

The data presented in this study emerged from the Research on Asian Psychotropic Prescription Pattern for Antidepressants (REAP-AD 2013), a pharmacoepidemiological study evaluating the antidepressant prescription pattern in patients with various mental disorders. The study centres were in Mainland China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Singapore, Taiwan, and Thailand.

The study was carried out across 42 psychiatric centres in 10 countries and regions. Data collection followed the same procedure at each centre and was carried out between March and June 2013. Each centre recruited patients on a specified date. To be included in the study, patients were required to be prescribed an antidepressant on the day of survey irrespective of the primary psychiatric diagnosis. There were no exclusion criteria. On the day of the survey, all consecutive patients seen in the outpatient services, psychiatry inpatient services, and consultation- liaison services were eligible to participate in the study.

The study protocol was approved by the Ethics Review Committee of the institutes in which the study was conducted. All patients were informed about the aim of the study and only those who provided written or verbal consent according to the requirements of the relevant ethics committee were included. The diagnosis of specific psychiatric disorder was based on the ICD-1016 or DSM-IV criteria. (17) As per the data collection, if a patient had co-morbid medical illness, it was also recorded. …

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