[Monitoring antidepressant use in acute hospital]

To carry out a prospective study on the current use of antidepressants (ADs) in an acute hospital, in order to determine the prescription sources, therapeutic indications, safety and monitoring of these drugs and their use at patient discharge.

To this end the therapeutic drug profiles of non-psychiatric inpatients treated with tri-cyclic antidepressants, selective serotonin re-uptake inhibitors (SSRIs) or monoamine oxidase inhibitors (MAOIs) were prospectively reviewed. The following was collected from the patientsâ medical record: reason for admittance, AD indication, prescription source (primary care or in-hospital), modifications of antidepressant treatment during stay, drug-related adverse events (DRAEs), interactions with other drugs, and whether patients were still on antidepressants upon discharge. The mean numer of daily inpatients was 382.6, of which 4.4% received ADs (11-25). Females were 67.5% and males were 32.5%, with a mean age of 67 years (37-92). The total number of patients studied was 126. Prescribed SSRIs represented 73% of cases (92), whereas tricyclic antidepressants represented 27% (34). Prescription originated in primary care for 79.4% of cases (29% tricyclics, 71% SSRIs) and within hospital for 20.6% of cases (tricyclics 11, SSRIs 15), p = 0.02. AD indications were endogenous depression in 72.2%, reactive depression in 7.1%, neuropathic pain in 7.1%, cancer-related pain in 2.4%, and indications not specified in medical records in 11.1%. Treatment was ongoing at patient discharge in 97.5% of cases.

AD prescription source was most commonly primary care. Prescription of ADs for unauthorised indications was seen: management of dementia in the elderly and shyness, support treatment for fibromyalgia, and migraine prophylaxis. In virtually all inpatients on ADs prescriptions were maintained without modification during stay. In the follow-up of patients on ADs, no clinically significant interactions leading to treatment changes were seen.