title: Factors Associated With Antidepressant Dosing in Asia: Findings From the Research on Asian Psychotropic Prescription Study.
abstract: In this study, we sought to examine factors associated with dosing of antidepressants (ADs) in Asia. Based on reported data and clinical experience, we hypothesized that doses of ADs would be associated with demographic and clinical factors and would increase over time. This cross-sectional, pharmacoepidemiological study analyzed data collected within the Research Study on Asian Psychotropic Prescription Pattern for Antidepressants from 4164 participants in 10 Asian countries, using univariate and multivariate methods. The AD doses varied by twofold among countries (highest in PR China and RO Korea, lowest in Singapore and Indonesia), and averaged 124 (120-129) mg/d imipramine-equivalents. Average daily doses increased by 12% between 2004 and 2013. Doses were significantly higher among hospitalized patients and ranked by diagnosis: major depression > anxiety disorders > bipolar disorder, but were not associated with private/public or psychiatric/general-medical settings, nor with age, sex, or cotreatment with a mood stabilizer. In multivariate modeling, AD-dose remained significantly associated with major depressive disorder and being hospitalized. Doses of ADs have increased somewhat in Asia and were higher when used for major depression or anxiety disorders than for bipolar depression and for hospitalized psychiatric patients.
authors.affiliation: From the *Department of General Psychiatry, Institute of Mental Health, Singapore; †Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China; ‡Department of Psychiatry, King George's Medical University, Chowk, Lucknow, India; §Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; ‖National Clinical Research Center for Mental Disorders & the Key Laboratory of Mental Health, Ministry of Health (Peking University). Peking University Institute of Mental Health (the Sixth Hospital), Beijing, China; ¶Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia; #Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India; **Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center and School of Medicine, Chang Gung University, Taiwan; ††Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan; ‡‡Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China; §§Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea; ‖‖Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan; ¶¶Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; ##Department of Psychiatry, Pushpagiri Medical College, Thiruvalla, India; ***Department of Psychiatry, Hasanuddin University Faculty of Medicine, Makassar, Sulawesi Selatan, Indonesia; †††Dr. Soetomo Hospital, Faculty of Medicine, Airlangga University, Jawa Timur, Indonesia; ‡‡‡Departments of Psychiatry, TMU-Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taiwan; §§§Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; ‖‖‖Department of Psychological Medicine, National University of Singapore; ¶¶¶Department of Pharmacology, National University of Singapore, Singapore; ###International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan; ****Research Division, Institute of Mental Health, Singapore; ††††International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, Massachusetts and Department of Psychiatry, Harvard Medical School, Boston, MA; ‡‡‡‡Department of General Psychiatry, Institute of Mental Health, Singapore.
authors.forename: Kamini
authors.initials: K
authors.lastname: Rajaratnam
authors.forename: Yu-Tao
authors.initials: YT
authors.lastname: Xiang
authors.forename: Adarsh
authors.initials: A
authors.lastname: Tripathi
authors.forename: Helen Fung Kum
authors.initials: HF
authors.lastname: Chiu
authors.forename: Tian-Mei
authors.initials: TM
authors.lastname: Si
authors.forename: Kok-Yoon
authors.initials: KY
authors.lastname: Chee
authors.forename: Ajit
authors.initials: A
authors.lastname: Avasthi
authors.forename: Sandeep
authors.initials: S
authors.lastname: Grover
authors.forename: Mian-Yoon
authors.initials: MY
authors.lastname: Chong
authors.forename: Hironori
authors.initials: H
authors.lastname: Kuga
authors.forename: Shigenobu
authors.initials: S
authors.lastname: Kanba
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: He
authors.forename: Min-Soo
authors.initials: MS
authors.lastname: Lee
authors.forename: Shu-Yu
authors.initials: SY
authors.lastname: Yang
authors.forename: Pichet
authors.initials: P
authors.lastname: Udomratn
authors.forename: Roy Abraham
authors.initials: RA
authors.lastname: Kallivayalil
authors.forename: Andi J
authors.initials: AJ
authors.lastname: Tanra
authors.forename: Margarita
authors.initials: M
authors.lastname: Maramis
authors.forename: Winston Wu-Dien
authors.initials: WW
authors.lastname: Shen
authors.forename: Norman
authors.initials: N
authors.lastname: Sartorius
authors.forename: Ee-Heok
authors.initials: EH
authors.lastname: Kua
authors.forename: Chay-Hoon
authors.initials: CH
authors.lastname: Tan
authors.forename: Rathi
authors.initials: R
authors.lastname: Mahendran
authors.forename: Naotaka
authors.initials: N
authors.lastname: Shinfuku
authors.forename: Min Yi
authors.initials: MY
authors.lastname: Sum
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
authors.forename: Kang
authors.initials: K
authors.lastname: Sim
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy*; D001208:Asia; D001714:Bipolar Disorder / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D006760:Hospitalization; D006801:Humans; D015999:Multivariate Analysis; D017891:Pharmacoepidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents