title: An audit to compare discharge rates and suicidality between antidepressant monotherapies prescribed for unipolar depression.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: South Essex Partnership University Foundation Trust, UK. ma393@cam.ac.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Agius
authors.forename: Jenny
authors.initials: J
authors.lastname: Gardner
authors.forename: Kathy
authors.initials: K
authors.lastname: Liu
authors.forename: Rashid
authors.initials: R
authors.lastname: Zaman
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use; D003155:Community Mental Health Centers; D003511:Cyclohexanols / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D004739:England; D006801:Humans; D008485:Medical Audit; D008803:Mianserin / Q000031:analogs & derivatives / Q000627:therapeutic use; D000078785:Mirtazapine; D010351:Patient Discharge / Q000706:statistics & numerical data*; D020280:Sertraline / Q000627:therapeutic use; D013405:Suicide / Q000523:psychology; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D000092864:Suicide Prevention
chemical_list: D000928:Antidepressive Agents; D003511:Cyclohexanols; D015283:Citalopram; D008803:Mianserin; D000069470:Venlafaxine Hydrochloride; D000078785:Mirtazapine; D020280:Sertraline