title: A managed care perspective of individualized care.
abstract: OBJECTIVE
  To examine the concept of individualized care for people with major depressive disorder, understand the drugs currently available, and review the implications of switching drug therapy solely for cost reasons.
  
  
  CONCLUSIONS
  The use of antidepressant drugs and their associated costs has been the subject of many pharmacoeconomic analyses. Each particular type of analysis has strengths and weaknesses, and their value can only be determined by stakeholders, all of whom have different perspectives. The development of new and better drugs to treat depression has had a significant impact on the nation.s rate of suicide. For managed care pharmacists, cost is often a concern, especially for patients who are treatment refractory. Studies have demonstrated that attempts to reduce prescription drug use in mental health settings increase other costs in a magnitude of $17 spent for every $1 saved. Adequate treatment, careful cross-tapering, and cultural concerns are addressed.
  
  
  CONCLUSIONS
  Pharmacists who practice in managed care must be cognizant of the implications of inadequate treatment of depression, the potential morbidity and mortality that may result from switching antidepressants based on cost alone, and the most appropriate ways to switch from one drug to another.
authors.affiliation: Washington State University College of Pharmacy, Spokane, WA, USA. ljcohen@wsu.edu
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Cohen
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D002391:Catchment Area, Health; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D017850:Economics, Pharmaceutical; D006801:Humans; D008329:Managed Care Programs / Q000191:economics*; D011788:Quality of Life; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors