Polypharmacy Prevalence in the Treatment of Unipolar Depression
Department of Psychiatry
Medical Subject Headings
Depressive Disorder; Drug Therapy; Polypharmacy; Treatment Outcome; Massachusetts
Life Sciences | Medicine and Health Sciences
Background: Unipolar depression is a complex mental illness, for which there are numerous pharmacological treatments available, and new treatment regimens are continuously being developed. The current rates of polypharmacy in the treatment of unipolar depression appear to be increasing. This trend of increasing polypharmacy is not without its complications, such as higher incidence of side-effects or drug-drug interactions, as well as increasing costs as medical care and pharmacotherapies become more expensive. Therefore, it is important to dissect whether patients are being placed on polypharmacy regimens only after previous trials with single medications have failed, or if these treatment guidelines are being bypassed, and if the use of polypharmacy actually increases the efficacy of treatment. This study attempts to answer these questions.
Methods: Patient names were provided by residents in the UMass psychiatry residency program. By obtaining subjects through resident physicians, the teaching methods of the institution can also be assessed. The charts of these patients were analyzed to collect data regarding names, types, duration of medication use and to access efficacy using the CGI. These data were then statistically analyzed using Excel and SPSS software.
Results: Of 160 reviewed charts, 135 subjects were included in the final analyses (others excluded due to incomplete data or no depression diagnosis). Patients were of a mean age 45 years old, predominately Caucasian (81%), and predominately female (58%). Patients were on average on 2.0 medications (SD=0.5) with 2.1 past trials. As predicted, a greater number of current antidepressant medications did not correlate with a greater change in CGI (mean change 1.7). The relationship of medication side-effects, numbers of past antidepressant trials, and contribution of substance abuse and trauma history are also examined as contributing factors to improvement in depressive symptomatology as measured by a change in the CGI.
Conclusions: Currently utilized treatments appear to improve depressive symptomatology, but the use of polypharmacy does not appear to improve treatment efficacy.
Rights and Permissions
This research was eventually published as follows: Anna Glezer, Nancy Byatt, Richard Cook Jr., Anthony J. Rothschild, Polypharmacy prevalence rates in the treatment of unipolar depression in an outpatient clinic, Journal of Affective Disorders, Volume 117, Issues 1-2, September 2009, Pages 18-23. Link to article on publisher's website
Glezer, Anna, "Polypharmacy Prevalence in the Treatment of Unipolar Depression" (2007). University of Massachusetts Medical School. Senior Scholars Program. Paper 44.