Article

Newer antidepressant drug use in East Asian psychiatric treatment settings: REAP (Research on East Asia Psychotropic Prescriptions) Study.

Institute of Mental Health/Woodbridge Hospital, Singapore.
British Journal of Clinical Pharmacology (Impact Factor: 3.69). 04/2007; 63(4):431-7. DOI: 10.1111/j.1365-2125.2006.02780.x
Source: PubMed

ABSTRACT Antidepressant use in East Asia is poorly documented. We compared patients given newer and older antidepressants to test the hypothesis, suggested in the literature, that use of newer antidepressants is associated with treatment settings rather than specific diagnostic categories.
We compared rates of use of older (pre1990) vs. newer antidepressants among 1898 patients identified as antidepressant treated at 21 centres in five East Asian countries (China, Japan, Korea, Singapore, Taiwan) in 2003. Demographics, treatment setting and clinical factors associated with preferential use of newer drugs were tested in univariate and multivariate analyses.
Newer antidepressants were included in the treatment regimens of 67.5% (N = 1282/1898) of study subjects. Prescription for newer antidepressants was significantly associated with younger age (z = -4.55, d.f. = 1888, P < 0.001), hospitalization [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.07, 1.64, P < 0.01] and treatment within psychiatric hospitals (OR 1.59, 95% CI 1.27, 2.00, P < 0.001). On multivariate analyses, treatment with newer antidepressants was independently associated with younger age (P < 0.001), country (P < 0.001) and treatment within private hospitals (P < 0.001), but not with sex or diagnosis of affective or anxiety disorders (all P > 0.1).
Demographic factors and treatment settings appear to influence antidepressant choice more than clinical factors such as diagnosis.

0 Bookmarks
 · 
319 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: According to WHO, it is estimated that major depression would be the second most leading cause of disability in the world by 2020. Drug utilization study is defined as study of the marketing, distribution, prescription and use of drugs in a society highlighting on the resulting medical, social and economic consequences. The main objective of this study was to find the utilization pattern of antidepressants prescribed in a tertiary care centre with major depression in hospitalized patients of Western Nepal. Methods: A hospital based observational study was done between 1st October 2009 and 31st March 2010 at Psychiatry Ward of Manipal Teaching Hospital, Nepal. Both qualitative and quantitative data was collected from bed side. The outcome variables were essential drug, generic and trade, treatment, groups of antidepressants and antidepressants used. The explanatory variables were age, gender, monthly income, employment of the patient. Z test and logistic regression was used for the analysis. P-value < 0.05 was considered to be statistically significant. This is the first study done to understand the utilization pattern of antidepressant drugs in hospitalized patients in Nepal. Results: Among the 240 psychiatric patients studied, 38 (15.8%) cases were suffering from major depression. Male and female patients were 44.7% and 55.3% respectively, 95% CI [28.9, 60.5 and 39.5, 71.1]. Depression was more common in housewives (42.1%) followed by teachers 18.4% and students 10.5%. Fluoxetine was the commonest antidepressants to be prescribed 42.1% followed by Amitriptyline 26.3%, Trazodone 21.1% etc. Psychiatrists has a tendency of prescribing essential drugs if monthly income <10000, 1.063 times as compared to monthly income >10000, 2.63 times more in Hindus and 1.197 times more in Brahmins than any other ethnic groups. 9.179 times more tendency of prescribing antidepressants by trade names in case of unemployed patients as compared to employed patients in Nepal. Conclusion: According to the utilization pattern of antidepressants it was found that among the Selective serotonin reuptake inhibitors Fluoxetine was used relatively higher than conventional drugs like Tricyclic antidepressants, recommend that there is a trend of using Typical antidepressants drugs for depression rather than Newer antidepressants. Keywords: Depression, Drug utilization study, Psychiatry, Nepal.
    Nepal Journal of Epidemiology. 01/2011; 1(5):144-152.
  • [Show abstract] [Hide abstract]
    ABSTRACT: This systematic review evaluated Chinese trials examining the efficacy of venlafaxine in the treatment of depression. Chinese databases CNKI and VIP and western databases were searched for blinded randomized controlled trial publications comparing venlafaxine to other antidepressants or placebo (in English or Chinese). Trials had to establish diagnosis of depression according to the Chinese Classification of Mental Disorders, Diagnostic and Statistical Manual of Mental Disorders, or International Classification of Diseases. Studies were excluded if more than 20% of participants had a primary diagnosis of dysthymia or if more than 15% had a primary diagnosis of bipolar disorder. Effect sizes were calculated as Hedges' g for rating scale scores and Mantel-Haenszel risk ratios (MH RR) for response and remission data. Effect sizes were combined in a fixed-effects model. A total of 25 studies were included. Nine trials compared venlafaxine to selective serotonin reuptake inhibitor; placebo-controlled trials were lacking. Quality was at best modest, and all trials were underpowered. There were more responders (MH RR, 1.08; 95% confidence interval [CI], 1.02-1.15) and remitters (MH RR, 1.12; 95% CI, 1.02-1.24) in venlafaxine groups compared with those in tricyclic antidepressant group. Hamilton Depression Rating Scale end point scores in the venlafaxine groups were lower (Hedges' g = 0.16; 95% CI, 0.04-0.27), and venlafaxine was better tolerated than tricyclic antidepressant (Hedges' g = 0.56; 95% CI, 0.37-0.74). There were no significant differences between venlafaxine and selective serotonin reuptake inhibitor on any of these parameters. Analyses of publication bias were inconclusive. Chinese researchers have published a number of randomized controlled trials comparing venlafaxine to active comparators, but study quality was found to be low. To make optimal use of their research potential Chinese, researchers will have to improve trial reporting and the peer-review process.
    Journal of clinical psychopharmacology 02/2011; 31(2):194-200. · 5.09 Impact Factor
  • Dataset: depression

Full-text (2 Sources)

View
30 Downloads
Available from
Jun 5, 2014