Utilization Study of Antidepressants in a Teaching Hospital of Sikkim and Adherence to Standard Treatment Guidelines

Aims: Depression is known to have an overarching negative impact on the quality of life of afflicted individuals. Mitigation of depression associated adverse outcomes is mostly reliant upon timely diagnosis and decisive intervention. Antidepressants and adjunct drugs constitute the pharmacological modalities for the therapy of depression, in addition to supportive non-pharmacological methods of management. This prospective cross-sectional observational study aims at analyzing the utilization of antidepressants in American Psychiatric Association (APA) categories of depression in a remote North-East Indian teaching hospital. Methods: Patients clinically diagnosed with depression based on Diagnostic and Statistical Manual of Mental Disorders (DSM) and prescribed with antidepressant medication, were included in the study. The data were analyzed based on demographic characteristics, prescribed antidepressant medication and co-prescribed adjunct drugs. Results: A total of 316 patients were included in the study. The SSRI class of antidepressants were prescribed most frequently (89%) followed by TCAs (6%) & SNRIs (4.4%). Escitalopram was the single most frequently prescribed antidepressant (51%) followed by sertraline (23%) & fluoxetine (11.4%). The SSRIs were used most frequently in bipolar disorder (94.7%), followed by depressive episode (89.2%) & mixed anxiety depressive disorder (88.2%). The utilization of SSRIs was more frequent in the ≤ 50 age group (90.3%) and in males (92.5%). Sedatives including benzodiazepines, were used in 78.8% and atypical antipsychotics in 8.9% of the patients. Conclusion: SSRIs are the most frequently used antidepressant class across all categories of depression. Benzodiazepines have been extensively co-prescribed. The pharmacotherapy of depression in this hospital conforms to currently available clinical evidence and treatment guidelines.