SELECTIVE SEROTONIN REUPTAKE INHIBITORS - ASSESSMENT FOR FORMULARY INCLUSION

Depression is a common and significant health problem associated with impairment in a patient's ability to function in their role (e.g. stud ent, worker, homemaker). and may have a fatal outcome in the case of s uicide. Recently there has been progress in developing new antidepress ant medications, such as the selective serotonin reuptake inhibitors ( SSRIs). These agents, while no more effective than the tricyclic antid epressant (TCA) drugs, are generally better tolerated than traditional medications used to treat depression, Further. because of their adver se effect profiles, they are generally better tolerated. and safer in overdose, than the TCAs. In response to concerns about aggregate healt hcare costs, formularies are being employed to control the direct cost s of prescription drugs. When direct drug costs alone are considered, the TCAs are initially less expensive than the SSRIs. However, compare d with those taking SSRIs, patients taking TCAs withdraw from treatmen t more frequently, have more accidents, experience mere adverse effect s that require treatment, and are more likely to die from an overdose (if it occurs). Furthermore, unsuccessful treatment may be due to nonc ompliance, which is frequently related to adverse effects. Medications have effects on indirect costs. For example, adverse effects may impa ir productivity and lead to accidents in the home and at work. There a re increased hospital and indirect costs of drugs used in overdose. Me dication noncompliance may lead to failure to recover from depression, which results in ongoing expense to the state in the form of disabili ty benefit payments. The largest cost savings are often associated wit h indirect costs, such as reduced benefit payments and improved produc tivity and earnings when treatment is successful. Taking all these con siderations together, it does not appear that TCAs, taken over time, a n any less expensive than the newer antidepressant medications.