Conventional Antipsychotic Prescription in Unipolar Depression, I: An Audit and Recommendations for Practice
J Clin Psychiatry 2003;64:568-574
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Despite narrow indications for
conventional antipsychotics in depression, recent reports confirm
a suspicion that they are widely prescribed in nonpsychotic
Method: Data from the case notes of over 510
patients with unipolar depression (unvalidated clinical
diagnoses) were collected between June 1997 and January 1998 from
community and acute units in 1 National Health Service (NHS)
Trust. The aim of this audit was to assess the extent and pattern
of antipsychotic prescription in this sample.
Results: More than a quarter (N = 138) of the
sample (N = 494) were currently prescribed an antipsychotic; 40%
of these received an antipsychotic without any recognized
indication. The mean time on antipsychotic therapy was 3 years.
Patients on antipsychotic therapy were, on average, taking twice
as many total medications as those not on antipsychotic therapy.
Patients with psychotic depression were taking an average of
nearly twice the antipsychotic dose of nonpsychotic patients.
Conclusion: Current clinical guidelines commend
careful antidepressant choice in preference to polypharmacy. A
number of drug choices for specific depressive presentations are
summarized from recent sources.