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A survey of antidepressant prescribing at a secure psychiatric hospital

Published online by Cambridge University Press:  20 January 2012

Camilla Haw ,
Marlene Kelbrick  and
Jean Stubbs
Camilla Haw*
Affiliation:
St Andrew's Healthcare, Northampton
Marlene Kelbrick
Affiliation:
St Andrew's Healthcare, Northampton
Jean Stubbs
Affiliation:
St Andrew's Healthcare, Northampton
*
Correspondence to: Dr Camilla Haw, Consultant Psychiatrist, St Andrew' Healthcare, Billing Road, Northampton, NN1 5DG, UK. E-mail: chaw@standrew.co.uk
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Abstract

Objectives: To study the frequency of use, indications and reported side-effects of antidepressants in the treatment of adult inpatients at a UK secure hospital.

Methods: Cross-sectional survey of the use of antidepressants for forensic rehabilitation patients, together with structured interviews with the treating psychiatrists.

Results: A total of 94 patients (40.7%) were prescribed antidepressants. The majority (68.9%) were prescribed SSRIs. Antidepressant usage was associated with female gender, depression and emotionally unstable personality disorder. Patients with learning disabilities and pervasive developmental disorders were less likely to be prescribed antidepressants than the rest. Only 10 patients (10.6%) had a formal diagnosis of depression, anxiety or obsessive compulsive disorder. For 67.0% of patients the plan was to continue with the antidepressant long-term. Although 83.0% of psychiatrists said they had asked about side-effects, few (14.9%) had asked about sexual side-effects and only 3.2% of patients were reported as having side-effects.

Conclusions: Long-term antidepressant usage in this population was common. The reported incidence of side-effects was very low and is likely to be much higher in reality. Psychiatrists should make regular inquiry about side-effects, including sexual side-effects when appropriate, as well as regularly reviewing the need for continuing treatment.

Keywords

Antidepressantsforensic psychiatryinpatientsoff-label prescribingside-effects
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 8 , Issue 1 , April 2012 , pp. 3 - 9
Copyright
Copyright © NAPICU 2012

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References

Ali, I.M. (1998) Long-term treatment with antidepressants in primary care: are sub-therapeutic doses still being used? Psychiatric Bulletin. 22:15–19.CrossRefGoogle Scholar
Anderson, I.M., Ferrier, I.N., Baldwin, R.C., Cowen, P.J., Howard, L., Lewis, G., Matthews, K., McAllister-Williams, R.H., Peveler, R.C., Scott, J. and Tylee, A. (2008) Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology Guidelines. Journal of Psychopharmacology. 22: 343–396.CrossRefGoogle ScholarPubMed
British Medical Association and Royal Pharmaceutical Society of Great Britain (2010) British National Formulary No. 60. London: British Medical Association and Royal Pharmaceutical Society of Great Britain.Google Scholar
Coid, J.W., Gault, S., Kahtan, N., Cook, A. and Jarman, B.(2001) Medium secure forensic psychiatry services: comparison of seven English health regions. British Journal of Psychiatry. 178(1): 55–61.CrossRefGoogle ScholarPubMed
Haw, C. (in press) Mood disorders. In: Puri, B., Treasaden, I. (eds) Forensic Psychiatry. Hodder Arnold.Google Scholar
Hu, X.H., Bull, S.A., Hunkeler, E.M., Ming, E., Lee, J.Y., Fireman, B. and Markson, L.E. (2004) Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. Journal of Clinical Psychiatry. 65(7): 959–965.CrossRefGoogle ScholarPubMed
Keller, M.B. (2000) Citalopram therapy for depression: a review of 10 years of European experience and data from U.S. clinical trials. Journal of Clinical Psychiatry. 61(12): 896–908.CrossRefGoogle ScholarPubMed
Kessler, R.C. (2003) Epidemiology of women and depression. Journal of Affective Disorder. 74(1): 5–13.CrossRefGoogle ScholarPubMed
Lieb, K., Zanarini, M.C., Schmahl, C., Linehan, M.M. and Bohus, M. (2004) Borderline personality disorder. Lancet. 364: 453–461.CrossRefGoogle ScholarPubMed
Micallef, J., Fakra, E. and Blin, O. (2006) Use of antidepressant drugs in schizophrenic patients with depression. Encephale. 32(2): 263–269.CrossRefGoogle ScholarPubMed
NHS Information Centre, Prescribing Support Unit (2010) Prescriptions Dispensed in the Community: England, Statistics for 1999 to 2009. ISBN 9781846364327. www.ic.nhs.uk/webfiles/publications/prescriptionsdispensed/Prescriptions_Dispensed_1999_2009%20.pdfGoogle Scholar
NICE (2009a). Depression: The Treatment and Management of Depression in Adults. National Institute for Health and Clinical Excellence, Clinical Guideline 90. http://guidance.nice.org.uk/CG90/NICEGuidance/pdf/EnglishGoogle Scholar
NICE (2009b). Borderline Personality Disorder: Treatment and Management. National Institute for Health and Clinical Excellence, Clinical Guideline 78. http://guidance.nice.org.uk/CG78/NICEGuidance/pdf/EnglishGoogle Scholar
Paton, C. (2000) Survey of new antidepressants in secondary care. International Journal of Psychiatry in Clinical Practice. 4(2): 105–109.CrossRefGoogle ScholarPubMed
Scott, J. (1988) Chronic depression. British Journal of Psychiatry. 153: 287–297.CrossRefGoogle ScholarPubMed
Singh, S.P., Singh, V., Kar, N. and Chan, K. (2010) Efficacy of antidepressants in treating the negative symptoms of chronic schizophrenia: meta-analysis. British Journal of Psychiatry. 197: 174–179.CrossRefGoogle ScholarPubMed
SPSS (2006) SPSS for Windows Release 14.0.2. Chicago: SPSS Inc.Google Scholar
Tyrer, P. and Bateman, A. (2004) Drug treatment for personality disorders. Advances in Psychiatric Treatment. 10: 389–398.CrossRefGoogle Scholar
Williams, V.S., Baldwin, D.S., Hogue, S.L., Fehnel, S.E., Hollis, K.A. and Edin, H.M. (2006) Estimating the prevalence and impact of antidepressant-induced sexual dysfunction in 2 European countries: a cross-sectional patient survey. Journal of Clinical Psychiatry. 67(2): 204–210.CrossRefGoogle ScholarPubMed
Williams, V.S., Edin, H.M., Hogue, S.L., Fehnel, S.E. and Baldwin, D.S. (2010) Prevalence and impact of antidepressant-associated sexual dysfunction in three European countries: replication in a cross-sectional patient survey. Journal of Psychopharmacology. 24(4): 489–496.CrossRefGoogle Scholar
Zanarini, M.C., Frankenburg, F.R., Dubo, E.D., Sickel, A.E., Trikha, A., Levin, A. and Reynolds, V. (1998) Axis 1 comorbidity of borderline personality disorder. American Journal of Psychiatry. 155(12): 1733–1739.CrossRefGoogle Scholar
Zimmerman, M., McGlinchey, J.B., Chelminshi, I. and Young, D. (2008) Diagnostic co-morbidity in 2300 psychiatric out-patients presenting for treatment evaluated with a semi-structured diagnostic interview. Psychological Medicine. 38: 199–210.CrossRefGoogle ScholarPubMed
Zimmerman, M., Galione, J.N., Attiullah, N., Freidman, M., Toba, C., Boerescu, D.A. and Ragheb, M. (2010) Underrecognition of clinically significant side effects in depressed outpatients. Journal of Clinical Psychiatry. 71(4): 484–490.CrossRefGoogle ScholarPubMed