Review of use of newer antidepressants

<p><strong>Objective:</strong>To examine the use of fluoxetine and moclobemide within the Royal Hobart Hospital, a 500-bed general teaching hospital. Study procedure: A drug utilisation review of fluoxetine and moclobemide was retrospectively performed. The medical records of 97 patients who had received therapy with these agents during the period January 1992 to April 1993 were studied, principally to determine whether these were being used as the first-line treatment of depression or as a second-line option when patients could not tolerate or did not respond to the tricyclic antidepressants. </p> <p><strong>Results: </strong>The mean age (±SD) of the patients in the sample was 47.2 ± 17.3 years, and 62 (63.9%) were females. Of the patients studied, 46 had received moclobemide, 40 fluoxetine, and 11 both agents at different times. Most patients had a diagnosis of major depression (46.4%), schizophrenia with suicidal ideation (15.5%) or adjustment disorder with depressed mood ('reactive depression', 12.4%). The median duration of therapy for each agent was 9 months (range: 1-17 months). Most of the patients (over 80%) commenced on either agent had remained on it until the time of the review. Less than half of all the patients had previously received therapy with either a tricyclic antidepressant (41.7%) or traditional monoamine oxidase inhibitor (6.3%). The tricyclics were generally ceased because of ineffectiveness (42.5%), the risk of suicide (20%) or adverse effects (5%). Eighteen patients (18.6%) had evidence of ischaemic heart disease, which could justify the use of newer antidepressants. </p> <p><strong>Conclusions: </strong>Overall, the results of the review suggest overuse of the newer antidepressants, when treatment with older and less expensive, but equally effective, agents may be indicated. </p>