title: Timing of adjunctive therapy in the treatment of depression: a chart review.
abstract: BACKGROUND
  The objective of this study was to examine the evolution of antidepressant switch and adjunctive therapy.
  
  
  METHODS
  This chart review was conducted at 6 primary psychiatric clinics or hospitals, in Tokyo, Japan. A chart review of longitudinal prescriptions was conducted regarding 633 outpatients with major depressive disorder for up to 2 years after their first visit. Patients who had already received antidepressants prior to the visit were excluded.
  
  
  RESULTS
  22.6% (N=143) of the patients completed or continued the outpatient treatment over the 2 years while 27 (4.3%), 23 (3.6%), and 439 (69.4%) patients discontinued it due to hospitalization, referral to another clinic, and loss to follow-up, respectively. A total of 597 episodes of antidepressant treatment were identified. Among them, 482 episodes (80.7%) were associated with the suggested dose ranges while antidepressant drugs were under-dosed in 19.3% (N=115) of the episodes. 50 patients (7.9%) received adjunctive therapy; it was employed after a median of only one antidepressant had been tried.
  
  
  CONCLUSIONS
  Psychiatrists may be hasty in prescribing an adjunctive therapy in the treatment of depression.
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Tarumi
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tani
authors.affiliation: Department of Psychiatry, Komagino Hospital, Tokyo, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Den
authors.affiliation: Department of Psychiatry, Asakadai Mental Clinic, Saitama, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Sawada
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sakurai
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: C
authors.initials: C
authors.lastname: Tsutsumi-Ozawa
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Ohtani
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Mimura
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Uchida
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002491:Central Nervous System Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged
chemical_list: D000928:Antidepressive Agents; D002491:Central Nervous System Agents