An audit to compare discharge rates between antidepressant monotherapies prescribed for pure unipolar depression versus depression in the presence of other indications.
BACKGROUND
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.


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 .


CONCLUSIONS
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.


CONCLUSIONS
These results suggest that co-morbid undiagnosed other mental illness may be a cause of 'resistant depression'.
Agius
Mark
M
South Essex Partnership University Foundation Trust, UK. ma393@cam.ac.uk
Gardner
Jenny
J
Liu
Kathy
K
Zaman
Rashid
R
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use; D003155:Community Mental Health Centers; D015897:Comorbidity; D003511:Cyclohexanols / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D004739:England; D005473:Fluoxetine / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit; D008803:Mianserin / Q000031:analogs & derivatives / Q000627:therapeutic use; D000078785:Mirtazapine; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D020280:Sertraline / Q000627:therapeutic use; D013405:Suicide / Q000523:psychology; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D000092864:Suicide Prevention
D000928:Antidepressive Agents; D003511:Cyclohexanols; D005473:Fluoxetine; D015283:Citalopram; D008803:Mianserin; D000069470:Venlafaxine Hydrochloride; D000078785:Mirtazapine; D020280:Sertraline