Survey of new antidepressants in secondary care

INTRODUCTION: There are no conclusive data to support the superior efficacy of any one antidepressant, while costs and side-effects are known to differ. The use of venlafaxine has been observed to be increasing within local services and this is associated with significant cost. This survey examined the patterns of use of new antidepressants by psychiatrists in the UK. METHOD: 188 questionnaires were sent to hospital pharmacists. The doses of fluoxetine, paroxetine, sertraline and venlafaxine used for the treatment of depression over a 1-week census period were recorded, together with the total quantities of each drug supplied by hospital pharmacies in the financial year 1997/1998. RESULTS: 84 completed replies were received (45%), with a total number of 2060 prescriptions for depression, making this the largest survey to date of antidepressant prescribing by psychiatrists. Fluoxetine and paroxetine were associated with less dosage titration and cost less per treatment month than sertraline and venlafaxine. CONCLUSION: Venlafaxine has not been consistently proven to be more effective than other antidepressants and is more costly, yet its use by psychiatrists is increasing nationally. Comparative data such as these are not routinely available for hospital care in the UK. The new NHS will bring more demand for such data and more accountability for its content. (Int J Psych Clin Pract 2000; 4:105-109).