Was Cipriani right? Audits to compare discharge rates and suicidality between antidepressant monotherapies used in a British community mental health team.

INTRODUCTION

a Metanalysis by Cipriani recently showed that certain antidepressants were more effective and better tolerated than others. We wished to see whether these findings were reflected in the outcomes of depression treatment in our Community Mental Health Team (CMHT).

SUBJECTS AND METHODS

we related medication choice and dosage range to outcomes of treatment as reflected by discharge rates and suicidality.

RESULTS

in this paper we emphasize the relationship of Dose Range to outcome.

DISCUSSION

Our results are in accord with those of Cipriani. We note that Prescription of 'the four' was associated with a greater percentage of patients discharged from the clinic than 'the others'. Sertraline was the antidepressant most likely to reduce suicidality in our sample. For patients with unipolar depression, discharge rates were higher when they were prescribed one of the four medications indicated by Cipriani and highest when prescribed escitalopram. For patients who also had other indications, discharge rates were higher for the group other than the four antidepressants identified by Cipriani and highest for fluoxetine. Regarding Dose Ranges, we note that wheras many patients had their dosage titrated upwards from the starting dose, most did not have the dosage titrated to the highest dose of the relevant medication.

CONCLUSION

it does appear that the antidepressants identified by Cipriani are effective compared with other monotherapies. Medication doses need to be optimised in order to achieve optimal treatment in Depression. Our results suggest that co-morbid undiagnosed other mental illness may often be a cause of 'resistant depression'. We recommend that all CMHTs should carry out audits of their prescribing practice in order to optimise treatment outcomes.