Patterns of antidepressant prescriptions : I acute phase treatments.

Although depression is an eminently treatable condition, inadequate pharmacotherapy is far too common. Lack of uniform standards of care across different settings characterises psychiatric practice in a developing country like India. But, there have hardly been any attempts at assessing the standards of care being delivered. A case note study was carried out of patients attending a general hospital psychiatric unit with depression, over a one year period, to evaluate the nature and adequacy of antidepressant therapy. Prescribing patterns in 108 cases fulfilling the selection criteria, were examined. The sample consisted mainly of young to middle aged patients, predominantly female, with moderately severe depressive episodes. Antidepressants were prescribed universally with TCAs (mainly Imipraminc), followed by Fluoxetine being the most common drugs used. Pharmacotherapy was often found to be deficient in several areas such as, starting doses, rate of increase in dose, maximum doses used, dose titrations, duration of treatment, change of drugs, recording of side effects and compliance etc. Results regarding norms for adequate doses and periods of treatment before switching drugs, for the kind of patients included in this study, were unclear, and need to be explored further. Inadequate treatment can have a number of adverse consequences, hence some guidelines for minimum standards of care while undertaking antidepressant treatment need to be formulated for India and other developing countries, as none exist at present.