An audit to compare discharge rates between antidepressant monotherapies prescribed for pure unipolar depression versus depression in the presence of other indications.
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INTRODUCTION: It has been demonstrated that there are differences in the efficacy and acceptability of commonly prescribed antidepressants (Cipriani et al. 2009). This meta-analysis showed that escitalopram, sertraline, venlafaxine and mirtazapine were the most effective in the acute treatment of unipolar depression in adults. In this audit, these most effective antidepressants will be referred to as 'the four', whilst other antidepressants will be referred to as 'the others'. We aimed to analyse prescribing patterns of antidepressant monotherapies in Bedford East Community Mental Health Team. We also aimed to compare the efficacy of antidepressant monotherapies in patients with unipolar depression or patients with depressed mood and also other psychiatric indications within Bedford East Community Mental Health Team, using discharge rates from the out-patient clinic as the outcome measure. We aimed to compare the efficacy of 'the four' versus 'the others' in patients with unipolar depression patients with depressed mood and also other psychiatric indications at within Bedford East Community Mental Health Team , using discharge rates from the out-patient clinic as the outcome measure. SUBJECTS AND METHODS: We included all patients on an antidepressant monotherapy in Bedford East Community Mental Health Team in our analysis (206 patients in total) (Figure 1). We examined the clinical notes for each patient to assess whether they were diagnosed with unipolar depression or another psychiatric condition, and whether they had been discharged from the out-patient clinic after being prescribed the antidepressant. This allowed us to calculate discharge rates for each antidepressant monotherapy. RESULTS: For patients with unipolar depression, discharge rates were higher when they were prescribed one of 'the four' and highest when prescribed escitalopram. For patients with other indications, discharge rates were higher for 'the others' and highest for fluoxetine . DISCUSSION: A greater percentage of patients with unipolar depression were discharged from clinic compared with patients treated with antidepressant monotherapy for depressed mood and also other psychiatric indications. CONCLUSION: These results suggest that co-morbid undiagnosed other mental illness may be a cause of 'resistant depression'. (+info)
An audit to compare discharge rates and suicidality between antidepressant monotherapies prescribed for unipolar depression.
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INTRODUCTION: It has been demonstrated that there are differences in efficacy and acceptability of commonly prescribed antidepressants (Cipriani et al. 2009). This meta-analysis showed that escitalopram, sertraline, venlafaxine and mirtazapine were the most effective antidepressant monotherapies in the acute treatment of unipolar depression in adults. We aimed to analyse prescribing patterns of antidepressant monotherapies in Bedford Hospital. We intended to compare the efficacy of antidepressant monotherapies in patients with unipolar depression at Bedford East CMHT, using discharge rates and rates of reduced suicidality (including suicidal ideation and Behaviour) after treatment by the CMHT as the outcome measure. We also decided to compare the efficacy of 'the four' versus 'the others' in patients with unipolar depression in Bedford East CMHT, using discharge rates and rates of reduced suicidality (including suicidal ideation and Behaviour) after treatment by the CMHT as the outcome measures. SUBJECTS AND METHODS: We identified and included all patients with unipolar depression prescribed an antidepressant monotherapy in Bedford East CMHT. We identified patients who were discharged after treatment, as well as patients who were suicidal before treatment, and after treatment. Hence we could work out discharge rates and reduction in suicide rates for each antidepressant monotherapy. These were then compared, using graphs. RESULTS: The most frequently prescribed antidepressant monotherapy was citalopram. 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. DISCUSSION: This audit in a small group of patients suggests that prescription of 'the four' leads to a higher discharge rate than 'the others'. Regarding suicidality, this audit in a small group of patients suggests that sertraline is the most effective antidepressant monotherapy in reducing suicidality in patients with unipolar depression. CONCLUSION: The study has several limitations, however it does appear that the antidepressants identified by Cipriani are effective compared with other monotherapies. We recommend that all CMHTs should carry out audits of their prescribing practice. (+info)
The role of serotonin in the enhancement of long-term memory resulting from predator detection in Lymnaea.
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Profound blockage of CXCR4 signaling at multiple points using the synergy between plerixafor, mirtazapine, and clotrimazole as a new glioblastoma treatment adjunct.
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