Mental-health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia.
Psychiatr Danub. 2021 Sep;33(Suppl 9):47-54.
Antidepressants (AD) are widely used in the treatment of mood disorders and administered for mental disorders coded across other diagnostic categories. However, inaccuracy in AD prescription may lead to unresponsive cases, decreased compliance, and treatment discontinuation. Following a one-way cross-sectional study design, we aimed to analyze the AD prescription patterns in routine clinical practice in Moscow, as compared to clinical guidelines, taking the capital as representative of the Russian national experience.
We studied 537 medical case records of inpatients and outpatients who had received treatments on an arbitrarily chosen day, focusing on classes, doses, drug combinations, and switching patterns for AD prescription. All statistical calculations (descriptive statistics, between group comparisons using Fisher exact, binominal and Pearson chi-square tests, significant at two-tailed p<0.05) were performed with the IBM SPSS 27.
15% of inpatients and 52% of outpatients with mental disorders received ADs. ADs were prescribed for major depressive disorder and other diagnoses, including the majority of schizophrenia spectrum disorders and non-organic conditions. Selective serotonin reuptake inhibitors, particularly fluvoxamine, were used most often for outpatient and inpatient settings, but at lower average dose rather than recommended, while tricyclic ADs were more likely to be correctly administered for severe depression. ADs were often prescribed within combined treatment rather than monotherapy, but clinical recommendations were not strictly followed in relation to the drug choice, combination with antipsychotic agents and switching strategies.
The clinical reality of AD prescriptions in the studied psychiatric setting differed from the clinical guidelines, insofar as the choice of AD medication did not always follow evidence-based recommendations. Choice and dosage of ADs should properly follow duration and severity of the illness, and the clinical profile of disorders.
抗抑郁药（AD）广泛用于治疗情绪障碍，并用于治疗其他诊断类别中的精神障碍。然而，AD 处方不准确可能导致无反应病例、依从性降低和治疗中断。我们采用单向横断面研究设计，旨在分析莫斯科常规临床实践中的 AD 处方模式，并与临床指南进行比较，以首都为代表，反映俄罗斯的国家经验。
我们研究了 537 名住院和门诊患者的病历，这些患者在任意选择的一天接受了治疗，重点研究 AD 处方的类别、剂量、药物组合和转换模式。所有统计计算（描述性统计、使用 Fisher 精确检验、二项式和 Pearson χ2 检验的组间比较，双侧 p<0.05 有统计学意义）均使用 IBM SPSS 27 进行。
15%的住院患者和 52%的门诊精神障碍患者接受了 AD。AD 用于治疗重性抑郁障碍和其他诊断，包括大多数精神分裂症谱系障碍和非器质性疾病。选择性 5-羟色胺再摄取抑制剂，特别是氟伏沙明，用于门诊和住院环境最常用，但平均剂量低于推荐剂量，而三环类 AD 更可能用于治疗严重抑郁症。AD 通常在联合治疗中开处方，而不是单一疗法，但在药物选择、与抗精神病药物联合使用和转换策略方面，并未严格遵循临床建议。
在所研究的精神科环境中，AD 处方的临床实际情况与临床指南不同，因为 AD 药物的选择并不总是遵循基于证据的建议。AD 的选择和剂量应适当遵循疾病的持续时间和严重程度，以及疾病的临床特征。
