Research Article

Increase of antipsychotic medication in depressive inpatients from 2000 to 2007: results from the AMSP International Pharmacovigilance Program

A. Konstantinidis^a1, K. Papageorgiou^a1, R. Grohmann^a2, A. Horvath^a3, R. Engel^a2 and S. Kasper^a1 c1

^a1 Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

^a2 Department of Psychiatry, Ludwig Maximilians University, Munich, Germany

^a3 Psychiatric Private Clinic Sanatorium Kilchberg/Zurich, Switzerland

Abstract

While international guidelines recommend monotherapy with antidepressants for depressed patients, recent investigation has demonstrated augmenting effects of antipsychotics (APs) in patients with major depression. We set out to investigate the use of APs in a European sample of depressed inpatients and the possible changes in their prescription over the period from 2000 to 2007. On two reference days in the years 2000 (32 psychiatric institutions, N=1078) and 2007 (54 psychiatric institutions, N=1826), the following data were recorded for all depressed inpatients (ICD-10: F32.00, F32.01, F32.1, F32.10, F32.11, F32.2, F33.0, F33.00, F33.01, F33.1, F33.10, F33.11, F33.2), monitored as part of the AMSP (Arzneimittelsicherheit in der Psychiatrie) surveillance programme: age, sex, ICD-10 diagnosis and all medication applied on that day. Depressed inpatients with psychotic symptoms were excluded. We found a significant increase in the number of AP-treated inpatients from 37.9% in 2000 to 45.8% in 2007 (χ²=17.257, p<0.001). The number of inpatients who received an atypical AP rose significantly between 2000 and 2007, from 12.8% to 28.3% (χ²=93.37, p<0.001). On the contrary, the percentage of inpatients receiving typical APs showed a significant decrease from 30.2% to 24.1% over the same period (χ²=13.179, p<0.001). Examining only the subgroup of severely depressed inpatients we found an increase in the number of AP-treated inpatients, but this was not statistically significant (χ²=2.047, p=0.15). Our study revealed a significant increase in the usage of atypical APs. However, this effect was not only due to augmentation strategies for severely depressed inpatients. Further studies are needed to examine possible putative effects of AP augmentation treatment in mild to moderate depression.

(Received December 17 2010)

(Reviewed March 09 2011)

(Revised April 12 2011)

(Accepted April 13 2011)

(Online publication May 17 2011)

Key Words:

• Antipsychotics;
• depression;
• inpatients

Correspondence:

^c1 Address for correspondence: S. Kasper, M.D., Professor and Chair, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Tel.: ++431 404003568 Fax: ++43 1 404003099 Email: sci-biolpsy@meduniwien.ac.at