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A ONE-DAY CROSS-SECTIONAL STUDY OF ANTIDEPRESSANTS PRESCRIPTION PATTERNS IN PUBLIC MENTAL HEALTH SERVICES: CLINICAL GUIDELINES VS REAL CLINICAL PRACTICE IN RUSSIA
Alexey Pavlichenko
; Mental-health Clinic No 1 named after N.A. Alexeev, Moscow, Russia
Daria Smirnova
; International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, Samara, Russia ; Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
Daria Susloparova
; Mental-health Clinic No 1 named after N.A. Alexeev, Moscow, Russia
Timur Syunyakov
; Mental-health Clinic No 1 named after N.A. Alexeev, Moscow, Russia; Zakusov Institute of Pharmacology, Moscow, Russia
George Kostyuk
; Mental-health Clinic No 1 named after N.A. Alexeev, Moscow, Russia
Sažetak
Background: 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.
Subjects and methods: 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.
Results: 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.
Conclusions: 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.
Ključne riječi
antidepressants; clinical guidelines; depression; monotherapy; prescription patterns
Hrčak ID:
274026
URI
Datum izdavanja:
16.9.2021.
Posjeta: 201 *