Prescribing Practices in the Treatment of Depression: A Study among North Indian Physicians

The purpose of this study was to explore the prescribing practices in a sample of physicians in the treatment of depression and to what degree these practices reflect research findings. 224 of 300 selected physicians (75%) responded to a 11-item questionnaire covering four major content areas: first-line preferences in the treatment of depression, antidepressant agents most associated with certain side effects, first-line preferences in the treatment of certain depressive subtypes and preference of ranking for five antidepressant factors (efficacy, safety, tolerability, cost and rapidity of action). Descriptive analyses for nominal data were performed to summarize our findings. Results of the study indicated that despite the lack of evidence of a significant difference in efficacy between older and newer agents, physicians perceive the newer agents [selective serotonin and serotonin norepinephrine reuptake inhibitors] to be more efficacious than the older drugs [tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs)] even in the melancholic and anxious depressive subtypes. Similarly, although sexual dysfunction and agitation appear to occur at similar rates with all the SSRIs, fluoxetine was perceived to be most likely to cause these side effects. While selecting an antidepressant, physicians appear to be most influenced by efficacy, followed by safety, rapidity of action and cost.