Consultation-liaison psychiatrists' use of antidepressants in the physically ill

In a practice-based, prospective study of 917 inpatients referred to a consultation-liaison psychiatry service and diagnosed as depressed, 41% were prescribed an antidepressant: 40% tricyclics, 35% selective serotonin reuptake inhibitors (SSRIs), 15% monoamine oxidase inhibitors (MAOIs)/reversible inhibitors of monoamine (RIMAs) (mainly moclobemide), and 11% tetracyclics (mianserin). Factors associated with choice of antidepressant type included age, referral for pain, length and seriousness of physical illness, type of physical illness, and concurrent antipsychotics (P < 0.01). Tetracyclics and MAOI/RIMAs were used significantly more often than tricyclics in the more severely physically ill and the elderly. The percentage of patients prescribed an antidepressant increased significantly over time, which is accounted for by the greater use of SSRIs across all age groups and degrees of seriousness of illness. There is a paucity of randomized controlled trials on which to base practice guidelines. Practice-based research such as this helps inform those guidelines.