Attitudes of Psychiatrists Toward Antipsychotic Depot Medication

Stephan Heres, M.D.; Johannes Hamann, M.D.; Werner Kissling, M.D.; and Stefan Leucht, M.D. 

Background: Since 2002, a second-generation depot antipsychotic has been available that potentially combines the advantages of depot administration and the favorable aspects of the so-called "atypical" antipsychotics. Nevertheless, long-acting injectable formulations are seldom prescribed in the treatment of schizophrenia.

Method: We surveyed 350 psychiatrists at an international conference as to their reasons for not prescribing a first- or second-generation depot antipsychotic for their patients diagnosed with schizophrenia or schizoaffective disorder.

Results: The most important factor opposing depot prescription pertaining to both classes is a presumed sufficient compliance with oral antipsychotic treatment. First-generation depots are avoided due to the threat of extrapyramidal side effects, whereas second-generation long-acting injectable drugs are considered to be associated with high treatment costs. Less than 36% of participants' patients have ever been offered antipsychotic depot treatment.

Conclusion: Aversions to prescribing depot treatment are frequent among psychiatrists and appear to be unrelated to the antipsychotic class. The stated reasons for not prescribing depots are generally not supported by the current evidence, and further studies are urgently needed to clarify the advantages of depot treatment.

(J Clin Psychiatry 2006;67:1948-1953)

Received Dec. 20, 2005; accepted April 11, 2006. From Klinik und Poliklinik fuer Psychiatrie und Psychotherapie der Technischen Universitaet Muenchen am Klinikum rechts der, Muenchen, Germany.

Dr. Heres has received honoraria from Janssen-Cilag, Sanofi-Aventis, Pharmastar, and Johnson & Johnson. He has accepted travel or hospitality payment from Janssen-Cilag, Sanofi-Aventis, Johnson & Johnson, Pfizer, Bristol-Myers Squibb, AstraZeneca, Lundbeck, Novartis, and Eli Lilly. Dr. Hamann has received honoraria and/or research support from Janssen-Cilag, Sanofi-Aventis, Astra Zeneca, and Bristol-Myers Squibb. Dr. Kissling has received honoraria from Janssen-Cilag, Sanofi-Aventis, Johnson & Johnson, Pfizer, Bristol-Myers Squibb, AstraZeneca, Lundbeck, Novartis, and Eli Lilly. Dr. Leucht has received honoraria and/or research support from Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, Janssen-Cilag, Johnson & Johnson, Pfizer, and Lundbeck.

The authors thank all participants for the time and effort they spent on the current survey.

Corresponding author and reprints: Stephan Heres, M.D., Klinik und Poliklinik fuer Psychiatrie und Psychotherapie der Technischen Universitaet Muenchen am Klinikum rechts der, IsarMoehlstrasse 26, 81675 Muenchen, Germany (e-mail: s.heres@lrz.tum.de).