Antidepressant Prescribing Practices of Outpatient Psychiatrists

Olfson, Mark; Marcus, Steve; Pincus, Harold Alan; Zito, Julie Magno; Thompson, James Westfall; Zarin, Deborah A.

doi:10.1001/archpsyc.55.4.310

Cited by 141 publications

(86 citation statements)

References 44 publications

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“…These results are in accordance with the results of previous studies conducted in France. [1][2][3][4]6,12,[28][29][30][31][32][33][34] In France, benzodiazepines are somewhat more frequently prescribed than Z-drugs, compared to other countries. In Sweden and in the UK, Z-drugs are more frequently prescribed than the conventional benzodiazepines.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Lasserre

Younès

Blanchon³

et al. 2010

Br J Gen Pract

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The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients. AimTo analyse discrepancies between GPs' opinions and practice when prescribing psychotropic drugs to older patients. SettingPostal surveys sent to GPs all over mainland France. Design of studyCross-sectional postal study. MethodA questionnaire collected data on characteristics of GPs' practices, their opinions about psychotropic drug consumption in older people, and a full description of their last older patient receiving a psychotropic drug and seen last by the GP on that particular day. ResultsA total of 350 participating GPs saw 2498 patients aged ≥65 years. Among these patients, the prevalence of psychotropic use was 32.1% (803/2498) for anxiolytics/hypnotics, and 17.5% for antidepressants (438/2498). A total of 91% of GPs agreed that it was possible to reduce or stop psychotropic drugs for these patients. Characteristics of 339 patients taking psychotropic drug were reported: 85.8% (291/339) received at least one anxiolytic/hypnotic and 56.9% (193/339) received at least one antidepressant; there were prescribed for more than 1 year in 68.4% (199/291) and 43.5% (84/193) of the cases respectively. GPs stated that it was possible to reduce or stop anxiolytic/hypnotic drugs for only 27% (79/291) of these patients. Barriers to doing this were patients' refusal (79%), and the absence of any local offer of psychotherapy (73%) or alternative therapy (70%). ConclusionA mismatch exists between GPs' intent (91%) and practice (27%) regarding reduction of psychotropic prescription in individuals aged ≥65 years. The barriers encountered should be examined further to help physicians improve management of psychotropic prescription.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Lasserre

Younès

Blanchon³

et al. 2010

Br J Gen Pract

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“…The reasons offered for the recent decline in suicide rates include lowered substance and alcohol use rates among the young (Centers for Disease Control and Prevention, 1998) and greatly increased prescribing of antidepressants to depressed individuals, with the largest increase in child, adolescent, and young adult populations (Olfson et al, 1998).…”

Section: Secular Changesmentioning

confidence: 99%

Suicidal ideation and behaviour

Korczak¹

2015

Paediatrics &Amp; Child Health

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Suicidal behavior is a matter of great concern for clinicians who deal with the mental health problems of children and adolescents. The incidence of suicide attempts reaches a peak during the mid-adolescent years, and mortality from suicide, which increases steadily through the teen years, is the third leading cause of death at that age. Clinicians need to know how to identify those at greatest risk for suicide from among the large number of suicide attempters who have a benign prognosis; how to provide treatment for the suicidal patient; how to advise and counsel the child, adolescent, and parental survivors of individual suicides; and how to provide expert consultation to educational and public health authorities on appropriate and inappropriate directions for suicide prevention programs. The parameter was written to aid clinicians in the assessment and treatment of children and adolescents exhibiting suicidal behavior or harboring suicidal ideation. EXECUTIVE SUMMARYThis summary provides an overview of the assessment and treatment recommendations contained in the Practice Parameter for the Assessment and Treatment of Children and Adolescents With Suicidal Behavior. This summary includes many of the most important points and recommendations that are in these practice guidelines. However, the treatment and assessment of suicidal patients requires the consideration of many important factors that cannot be conveyed fully in a summary, and the reader is encouraged to review the entire document. Each recommendation in the executive summary is identified as falling into one of the following categories of endorsement, indicated by an abbreviation in brackets following the statement. These categories indicate the degree of importance or certainty of each recommendation."Minimal Standards" [MS] are recommendations that are based on substantial empirical evidence (such as well controlled, double-blind trials) or overwhelming clinical consensus. Minimal standards are expected to apply more than 95% of the time, i.e., in almost all cases. When the practitioner does not follow this standard in a particular case, the medical record should indicate the reason."Clinical Guidelines" [CG] are recommendations that are based on empirical evidence (such as open trials, case studies) and/or strong clinical consensus. Clinical guidelines apply approximately 75% of the time. These practices should always be considered by the clinician, but there are exceptions to their application."Options" [OP] are practices that are acceptable but not required. There may be insufficient empirical evidence to support recommending these practices as minimal standards or clinical guidelines. In some cases they may be the perfect thing

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“…1,2 This increase in SSRI use may be explained by a broadened indication of SSRI, a different adverse effect profile, and a lower toxicity compared with classic tricyclic antidepressants. [3][4][5] Yet, despite a more favorable adverse effect profile, the use of SSRIs is not entirely risk free. [6][7][8][9] SSRIs block the reuptake of serotonin by platelets and decrease serotonin platelet concentration, which may lead to impaired aggregation and prolonged bleeding times.…”

Section: See Related Article P 1917mentioning

confidence: 99%

Inhibition of Serotonin Reuptake by Antidepressants and Cerebral Microbleeds in the General Population

Aarts

Akoudad

Noordam

et al. 2014

Stroke

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Background and Purpose-Serotonin reuptake inhibiting antidepressants decrease platelet aggregation. This may cause an increased risk of intracerebral hemorrhage. However, the risk of subclinical microbleeds, which are highly prevalent in middle-aged and elderly people, is unknown. We studied whether serotonin reuptake inhibiting antidepressants increase the frequency of cerebral microbleeds and secondarily whether they lower the presence of ischemic vascular damage.

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Antidepressant Prescribing Practices of Outpatient Psychiatrists

Abstract: During the late 1980s and early 1990s, there was a significant increase in the prescription of antidepressants by office-based psychiatrists. This increase was greatest for patients with less severe psychiatric disorders.

Cited by 141 publications

References 44 publications

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Suicidal ideation and behaviour

Inhibition of Serotonin Reuptake by Antidepressants and Cerebral Microbleeds in the General Population

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