Evaluation of indoor prescriptions of depression in psychiatry department of a tertiary care hospital in North India

Abstract

INTRODUCTIONDepression is a significant public health concern across all regions of the world and is strongly related to social conditions. Depression affects a person's ability to work, form and maintain relationships and destroys his/her quality of life. Depressive disorders are currently estimated to affect 350 million people worldwide with approximately 1 in 20 people reporting an episode of depression each year.1 Severe depression can lead to a suicidal attempt (responsible for 850000 deaths every year). An estimated 6-12% of the US population will experience depression at some time. The annual suicide rate is 12.93 per 100,000 individuals. Suicide is the tenth leading cause of mortality. In 2014, the total number of suicide deaths in the United States was 42,773. 2Recently conducted world mental health surveys indicate that major depression is experienced by 10-15% people in their lifetime and about 5% suffer from major depression in any given year.3,4 Lifetime prevalence of all depressive disorders taken together is over 20% that is one in five individuals. In Indian context, a recent large sample survey with rigorous methodology reported an overall prevalence of 15.9% for depression, which is similar to western figures. There is some suggestion that perhaps the prevalence of depression has increased over past few ABSTRACT Background: Depression is one of most common psychiatric illnesses affecting the human population and poses significant economic burden to society. Prescription for depression usually involves multiple medications sometime irrationally prescribed. Methods: Present study involved evaluation of 65 indoor prescriptions of patients diagnosed with depression from Psychiatry Department in a tertiary care hospital. The prescriptions were evaluated on basis of WHO Core Indicators for writing a good prescription. The demographic characteristics of the patient population were studied. Number of drugs prescribed per prescription and the average number per prescription were calculated to assess polypharmacy. The cost involved in treatment using latest market data from drug information source and the rationality of prescriptions were also evaluated. Results: 80% of the prescriptions were not in accordance with the WHO Core Indicators. An average of 2.415±1.102 medications were prescribed per prescription indicating polypharmacy. Insignificant difference was observed in cost per prescription per month of medicines when compared with lowest priced products available in market. Conclusions: Polypharmacy was found in most prescriptions and monotherapy was instituted in five prescriptions only, with clonazepam as the most prescribed antidepressant drug. Majority of prescriptions did not conform to WHO core indicators for prescription writing.