SEROTONIN REUPTAKE INHIBITORS AND THE ADEQUACY OF ANTIDEPRESSANT TREATMENT

Objective: To determine whether the use of serotonin reuptake inhibito rs (SSRIs) improves antidepressant medication prescribing patterns for both psychiatric and non-psychiatric physicians. Data Sources/Setting : Drug utilization review of 4,103 prescriptions for antidepressant me dications with patients diagnosed with depressive disorders over an ei ghteen-month period from the formulary records of a large insurance co mpany. Design: Using standards developed for clinical guidelines, vari ation in trial and treatment adequacy between drug types and physician specialty was studied. Principal Findings: Thirty-five percent of ini tial antidepressant trials were not prescribed for an adequate duratio n or at an adequate dosage level. SSRIs were more likely to be prescri bed adequately than any other antidepressant reviewed. Psychiatrists w ere more likely to prescribe antidepressants at an adequate dosage lev el, whereas :non-psychiatric physicians were more likely to attain ade quate duration of treatment. Conclusions: A greater reliance on SSRIs may increase the likelihood of maintaining adequacy in antidepressant treatments. Although higher in cost than other treatment choices, thei r lower side effect profile is likely to maximize patient satisfaction and physician and patient adherence to guidelines. In order to ensure effective and efficient antidepressant usage, such patterns must be i dentified and appropriate performance improvement strategies (e.g., To tal Quality Improvement, critical pathways) may be employed.