Antidepressant use patterns in clinical practices: comparisons among tricyclic antidepressants and selective serotonin reuptake inhibitors

Objective: Antidepressant use in clinical practice may differ from that in randomized controlled trials due to the complex interaction between patient s, prescribers and the health-care system. Method: A review of studies using data from actual clinical practice has fo und consistent differences in the prescribing patterns of tricyclic antidep ressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). Results: Patients who initiate therapy on SSRIs are more likely to complete a course of adequate dose and duration of antidepressant therapy than pati ents who initiate therapy on a TCA. Differences in prescribing patterns hav e also emerged among the most common SSRIs, fluoxetine, sertraline and paro xetine, that are also consistent over time, settings and countries. Conclusion: Given that the drugs studied are one constant across all the st udies, the antidepressants' underlying pharmacological differences in toler ability and other properties may provide an explanation for differences in prescribing patterns.