Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 101521

AbstractMaterial and MethodsResultsDiscussionConclusionKey MessageAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : June | Volume : 5 | Issue : 3 | Page : 573 - 577

Prescribing Trends in Depression – A Drug Utilization Study Done at a Tertiary Healthcare Centre

SUJOY RAY,BHARTI CHOGTU

Sujoy Ray, Final year MBBS student Kasturba Medical College, Manipal University, Manipal, India. Bharti Chogtu Associate Professor, Department of Pharmacology Kasturba Medical College, Manipal University Manipal, India.

Correspondence Address :
Sujoy Ray
c/o Dr. Amita Ray
B-2, Father Muller Quarters,
Kanakanady, Mangalore-575002
Phone No. 09916821079
Email: sujoyray@rediffmail.com

Abstract

Introduction: Depression is one of the most prevalent forms of mental illnesses.The ‘Global Burden of Disease’ study showed that depressive disorders were the fourth leading cause of burden among all the diseases. Depression accounted for 4.46% of the total DALYs (Disability Adjusted Life Years) and 12.1% of the YLDs (Years Lived with Disability) in 2002, as opposed to 3.7% of the DALYs and 10.7% of the YLDs in 1990.With the increase in the number of patients, there has been an increase in the number and the type of antidepressants which are available to the psychiatrists and other clinicians. This study was aimed to assess the current prescribing practice.

Materials and Methods: The data which was collected included information on the age, sex and the drug prescribed, including the group, subgroup, trade name, dosage and distribution in 50 outpatients who attended the psychiatry OPD.

Results: In this study, 82% of the subjects were females whereas 18% were males. Most of the patients were in the age group of 41-60 years followed by the 21–40 years age group, the above 60 years age group and the below 21 years age group. Most of the patients were prescribed selective serotonin reuptake inhibitors (SSRIs), followed by serotonin nor-epinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs). The most prescribed SSRI was Escitalopram.

Conclusion: In this study on depression, most of the subjects were females. Most of the patients were in the age group of 41–60 yrs. By and large, the newer groups of drugs, namely the SSRIs and the SNRIs seem to have replaced the older group, namely the TCAs. This seems to be in accordance with other research findings especially considering the fewer side effects of the newer group of drugs and the prolonged therapy which was needed to combat depression effectively.

Keywords

Depression, Antidepressants, Prescribing Patterns

Depression is an important global public health problem due to both, its relatively high lifetime prevalence and the significant disability that it causes. In 2002, depression accounted for 4.5% of the worldwide total burden of diseases (in terms of disability-adjusted life years). It is also responsible for the greatest proportion of burden which is attributable to non-fatal health outcomes, accounting for almost 12% of the total years which were lived with disability worldwide (1). The WHO defines depression as a pessimistic sense of inadequacy and a despondent lack of activity.

Depression can be defined as a mental state which is characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach. The accompanying signs include psychomotor retardation, or at times, withdrawal from interpersonal contact and vegetative symptoms such as anorexia and insomnia.(2) Depression affects different people in different ways – not everyone has the same symptoms. The symptoms of depression have an impact on patients both mentally and physically, typically preventing the sufferers from leading normal lives. The symptoms may be chronic or recurrent and in severe cases, can lead to suicide. The symptoms may include any, or a combination of the following, which have been experienced for more than two weeks:,[3,4] low/sad, irritable or indifferent mood , loss of interest and enjoyment in daily life andlack of energy. The physical symptoms of depression include fatigue and reduced activity, disturbed sleep or excessive sleep, changes in appetite and weight, loss of sex drive, unexplained aches and pains and changes in the menstrual cycle. Other symptoms of depression include poor concentration or reduced attention, difficulty in making decisions, tearfulness, restlessness, agitation or anxiety, low selfconfidence and self-esteem, feelings of guilt, inability to cope with life as before, etc (3).

Depression accounted for 4.46% of the total DALYs (Disability Adjusted Life Years) and 12.1% of the YLDs (Years Lived with Disability) in 2002, as opposed to 3.7% of the DALYs and 10.7% of the YLDs in 1990 (4).

General population surveys which were conducted in many parts of the world, including some which were conducted in the southeast Asian region countries showed that 15% to 20% children and adolescents suffered from depression and that the causes were mostly similar to that of the adult populations. Isolation from peers, family, and other emotional relationships; or the inability to keep one’s disappointments in his/her perspective and academic stress may lead to mental health problems (5).

Age standardized DALYs per 100000 population 2004 WHO figures for India, (4) (Table/Fig 1).

A drug utilization study is aimed at evaluating the factors which are related to the prescribing, dispensing, administering and the taking of medication and its associated events. These factors analyze the trend of drug usage at various levels in the healthcare system, irrespective of whether it is national, regional, local or institutional. They evaluate drug usage at a population level according to the age, sex, social class and morbidity among other characteristics. They also crudely estimate the disease prevalence to plan drug production and procurement.

Many studies have pointed to significant changes in the types of antidepressants that are being prescribed (6).The outpatient and medication based therapy for depression is becoming much more popular for the treatment of depression than for psychotherapy (7). Thus, it is important to know the current trend of drug usage and the effectiveness of the drugs which are used for depression.

Material and Methods

The data was collected as per the proforma which included age, sex and the drug which was prescribed including the subgroup, the trade name, the dosage and the distribution

Inclusion criteria
Patients of both the sexes in age group of 18-60 years.
Patients of both the sexes in age group of 18-60 years The patients with an established diagnosis of depression were included.

Th Criteria for a Major Depressive Episode in Adults (8)
A. Five (or more) of the following symptoms were present during the same two-week period and they represented a change from the previous functioning and at least one of the symptoms was (1) depressed mood or (2) loss of interest or pleasure. (1) Depressed mood for most of the day, nearly every day, as indicated by the subjective report (e.g., feeling sad or empty) or by the observation made by others (e.g., appearing tearful). (2) Markedly diminished interest or pleasure in all or almost all the activities most of the day, nearly every day (as indicated by the subjective account or by the observation made by others). (3) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in the appetite nearly every day. (4) Insomnia or hypersomnia nearly every day. (5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective, feeling of restlessness or being slowed down).(6) Fatigue or loss of energy nearly every day. (7) Feeling of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely selfreproach or guilt about being sick). (8) Diminished ability to think or concentrate or indecisiveness nearly every day (by the subjective account or as observed by others). (9) Recurrent thoughts of death (not just the fear of dying), recurrent suicidal ideation without a specific plan or a suicide attempt or a specific plan for committing suicide. B. The symptoms do not meet the criteria for mixed bipolar disorder. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not caused by the direct physiological effects of a substance (e.g., drug abuse or medication) or a general medical condition (e.g., hypothyroidism). E. The symptoms are not caused by bereavement—i.e., after the loss of a loved one; the symptoms persist for longer than two months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Exclusion criteria
Depression existing with other disorders likes bipolar disorder.

Patients with cardiovascular or any other comorbidity

Results

Females constituted 82% and males constituted 18% of the total patients (Table/Fig 2). The patient distribution in the different age groups is shown in (Table/Fig 3). Most were in the age group of 41- 60 years. The most commonly prescribed group of antidepressants was SSRIs (70%), followed by SNRIs (18%) and then by TCAs (12%). (Table/Fig 4).The most prescribed SSRI was Escitalopram 85.7%. Duloxetine was the most prescribed SNRI. ((Table/Fig 5) and Doxepin was the most prescribed TCA (66%). (Table/Fig 6). The drugs which were prescribed other than the antidepressants were benzodiazepines, H2 blockers and multivitamins. The duration of the treatment ranged from a minimum of three months to a maximum of three years ((Table/Fig 8).

Discussion

Although pharmacological intervention is the primary treatment modality for relieving the depressive symptoms, the efficacy and suitability of other therapeutic options should not be overlooked. Other therapeutic options include psychotherapy, somatic intervention and lifestyle adjustment. The most established psychotherapies that are thought to be useful in treating depressed patients are cognitive and interpersonal psychotherapy. The role of psychotherapy alone in the management of recurrent depression seems to be less promising than the role of the antidepressants alone (9). The somatic intervention involves electroconvulsive therapy (ECT) which is recommended for patients with treatment resistant depression, severe vegetative depression, psychotic depression and depression in pregnancy. ECT, which is administered weekly for one month and less frequently thereafter, may be as effective as aggressive pharmacotherapy in preventing relapse (10). Lifestyle adjustment involves a minimal use of alcohol, recreational drugs and caffeine and increased physical activity and sustained cardiovascular activities (11).

Pharmacological intervention includes the use of TCAs, SSRIs, SNRIs and MAOIs (Monoamine oxidase inhibitors). All drugs share at some level the primary effect on the serotonergic or the noradrenergic neurotransmitter system (12). Antidepressant drug therapy is divided into three phases: the acute phase, the continuation phase and the maintenance phase. The acute phase starts from the initiation of the therapy until remission (usually 6–12 weeks).The continuation phase is from remission to 6–9 months after the remission. The drugs of the acute phase are continued to prevent the relapse of depression. The maintenance phase is used in high risk patients like those with multiple episodes of depression, those with a history of suicidal thoughts, etc. They may receive maintenance treatment for 2-3 years or for lifelong (9).

Antidepressants do not differ in their overall efficacy and in their speed of response or long-term effectiveness, however, they differ in their side effects, their likelihood for the discontinuation of the symptoms and their ease of dose adjustment. Approximately 45– 60% of all the outpatients with uncomplicated depression respond to the antidepressants (i.e. achieve a 50% decrease in the baseline symptoms) but only 35–50% achieve remission (i.e., virtual absence of the depressive symptoms) (13).

In this study, the age group which was commonly affected was the middle age. Also, there has been a dramatic change in the prescribing trends since the advent of the newer group of drugs, namely the SSRIs, which are being prescribed more as also shown by some other studies (14). Studies to evaluate the recognition and the management of the depressed patients also need to be done. The methods to recognize/evaluate patients differ in different settings and many times depressed patients go untreated in primary care settings (15).

This study has taken into account only a small number of subjects and it has been conducted in a tertiary care centre, so it does notreflect the prescribing trends which are prevalent in the general practitioners. Different people may take services/support from different places as shown by certain studies (16). A larger multicentric trial would be more representative of the prescribing trends on a national and international level. Since SSRIs and SNRIs are relatively newer drugs, they may have some long term side effects at a later date.

TCAs, by inhibiting H1 receptors cause sedation. By blocking muscarinic receptors, they cause blurred vision, dry mouth, constipation, tachycardia and difficulty in urination. Blockage of the alpha-1 receptors leads to orthostatic hypotension and sedation. They affect cardiac conduction and this limits their use in the CAD patients. SSRIs don’t cause cardiovascular, histamine blocking or alpha-1 receptor side effects. But, insomnia, anxiety, irritability and decreased libido result from the excess stimulation of the 5HT2 receptors. The stimulation of the 5HT3 receptors in the CNS and the periphery contributes to the GI side effects like nausea, diarrhoea, emesis, etc. SNRIs have a similar side effect profile as the SSRIs (nausea, constipation, headache and sexual dysfunction). Immediate release Venlafaxine can induce sustained diastolic hypertension (17). Adverse events such as mania, hostile behaviour and suicide have been reported in teenagers who had been treated with SSRIs (18). Suicidal tendencies however, have shown variation with respect to one SSRI to the other and fluoxetine has been shown to cause less suicidal tendencies (19). A similar study in Sweden has shown a decrease in suicides as the effect of a primary care educational programme (20).

Depression may be commonly associated with chronic diseases in which case drug interactions with antihypertensives, hypoglycemics, etc. which are given for prolonged periods need to be studied. Such interactions may cause the physicians to prescribe drugs which may not be generally recommended for that group of population. Though it is seen that TCAs are less popular, they are more effective than SSRIs in treating severe depression (21). Other studies which are related to depression in specific situations like post-natal depression etc., should be done as the drugs which are used for treating them may differ from the ones which are given in cases of normal depression. Similarly, studies can be conducted in vulnerable groups such as students, especially those who have recently faced a transition from school to hostel/university life.

Although SSRIs are generally associated with higher drug acquisition costs than are TCAs, the total healthcare costs are at least offset, if not decreased, by reductions in the costs which are associated with the use of SSRIs. Escitalopram has a high affinity for the serotonin transporters. Also, in a study which compared citalopram with escitalopram, the latter was found to have a superior effect in major depressive disorders (22).

Long term studies favour SSRIs over TCAs and the results indicate that the effect of SSRIs is mainly due to the prevention of relapse (23). The popularity of SSRIs is mainly due to the ease in their use, their safety in overdose, their relative tolerability, and the broad spectrum of their uses.

Conclusion

Most of the patients in this study were females and the most susceptible age group was the 41-60 years age group. By and large, the newer group of drugs, namely the SSRIs and SNRIs, seem to have replaced the older group, namely the TCAs. This seems to be in accordance with other research findings (14), especially considering the fewer side effects of the newer group of drugs and the prolonged therapy which was needed to combat depression effectively.

Key Message

Significant changes in the antidepressants being prescribed. SSRIs are more popular than the TCAs.

Acknowledgement

Department of Psychiatry, KMC, Manipal. Department of Pharmacology, KMC, Manipal. No financial or material support was received. No paid support from JCDR was taken

References

1.
Revised global burden of disease (GBD) 2002 estimates. Geneva, World Health Organization, 2005; 667
2.
Sadock B, Sadock V, Ruiz P, (Editors). In Comprehensive textbook of psychiatry-Kaplan and Sadock’s, ninth Edition, Volume 1-Wolters Kluwer, Lippincott Williams and Wilkins, 2009; Pg. 923
3.
National Institute for Health and Clinical Excellence. 2009. Depression: the treatment and management of depression in adults (update). http://guidance.nice.org.uk/CG90
4.
Indian J Psychol Med Jan-Jun 2010 volume 32 issue 1.downloaded from Ijpm.info on March 30,2011 1.186.19.154
5.
Quyen Dinh Do Prida Tasanapradit. Depression and stress among the first year medical students in the university of medicine and pharmancy Ho Chi Minh city, Vietnam JHealth Res 2008; 22(suppl): 1-4
6.
Pincus HA, Tanielian TL, Marcus SC et al. Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialities. JAMA 1998; 279:526-531
7.
Olfson M, Marcus SC, Druss B. et. al. National trends in the outpatient treatment of depression. JAMA. 2002; 287:203-209
8.
Association Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. rev. Washington, D.C.: American Psychiatric Association, 2000:356,
9.
Frank E, Kupfer DJ, Perel JM, et al. Three-year outcomes for maintenance therapies in recurrent depression. Arch GenPsychiatry 1990; 47:1093-9
10.
Kellner CH, Knapp RG, Petrides G, Rummans TA, Husain MM, Rasmussen K et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression. Arch Gen Psychiatry 2006; 63: 1337
11.
Finley PR. Mood disorders: Major depressive disorders In: Ed Koda- Kimble MA (editor), Applied Therapeutics: The clinical use of drugs. 9th edition, Lippincott Williams USA 2009 p.79-1to 79-32
12.
Shelton RC, Lester N. SSRI’s and newer antidepressants, In, APA Textbook of Mood disorders, APA press, Washington DC 2006
13.
Mood disorders. In Sadock BJ, SadockVA (editors) Kaplan and Sadock’s concise textbook of psychiatry. 3rd ed Wolter Kluwer New Delhi. 2008 p. 200-225
14.
Sclar DA, Robinson LM, Skaer TL etal. Trends in the prescribing of antidepressant pharmacotherapy: office based visits, 1990-1995. Clin.Ther. 1998; 20: 871-884
15.
Simon GE, VonKorff M. Recognition, management, and outcomes of depression in primary care. Arch Fam Med. 1995; 4:99-105
16.
Regier DA, Narrow WE, Rae DSetal. The de facto US mental and addictive disorders service system: epidemiological catchment area prospective 1 year prevalence rates of disorders and services. ArchGen Psychiatry. 1993; 50:85-94
17.
O Donnell JM, Shelton RC. Drug therapy of depression and anxiety disorders.In: Brunton LL editor Goodman and Gilman’s The Pharmacological basis of therapeutics.12th edition. McGraw Hill Companies, Inc. Printed in China. 2011p. 397-416
18.
Cheung AH, Dewa CS, Levitt AJ. Clinical review of mania, hostility and suicide-related events in children and adolescents treated with antidepressants. Paediatr Child Health. 200 Oct; 10(8):457-63.
19.
Doggrell SA. Fluoxetine--do the benefits outweigh the risks in adolescent major depression? Expert Opin Pharmacother. 2005; Jan 6(1):147-50.
20.
Henriksson S, IsacssonG. Increased antidepressant use and fewer suicides in Jämtland county, Sweden, after a primary care educational programme on the treatment of depression. Acta Psychiatr Scand. 2006; Sep114(3):159-67.
21.
Antidepressant drugs. In KD Tripathi editor. Essentials of medical pharmacology 6th edition Jaypee Brothers: New Delhi. 2008.p. 446
22.
Moore N. Verdouz H. Fantino B. Prospective randomized, double blind study of efficacy of Escitalopram versus Citalopram in the outpatient treatment of Major depressive disorder. Int Clin Psychopharmacol 2005; 20(30): 131-7
23.
Frank L, Revicki DA, Sorensen SV, Shih YC. The economics of selective serotonin reuptake inhibitors in depression: a critical review. CNS Drugs. 2001; Jan15(1):59-83

DOI and Others

JCDR/2011/1384

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com