Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects

Abstract

Objective: To study the biases in the prescription of Selective Serotonin Reuptake Inhibitors and the variation between the literature and the perception of doctors prescribing SSRIs. Methodology: The five drugs under study were sertraline, fluoxetine, fluvoxamine, paroxetine, escitalopram. The factors influencing the psychiatrist’s perceptions/ practice considered in this study are: A) Pharmacokinetic factors of the drug (Contra indications, Drug efficacy, Onset of action, Duration of action and the Bioavailability) B) Uses of the drug (for Social Anxiety Disorder, Generalized Anxiety Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder and Post-Traumatic Stress Disorder) C) Side effects (Somnolence, Anxiety, Tremors, Anorexia and sexual dysfunction) D) Patient’s Demographics (Gender, Age group, Special Groups- Geriatrics and Adolescents) E) Commercial aspects (Retail Price, Availability, Brand Value of the Parent Brand and Interpersonal Skills of the Medical Representative). Discussion: Contra-Indications: Theoretically, all SSRIs have the same number of contra-indications, since they have the same mechanism of action, though fluoxetine and paroxetine have a relatively higher potential of drug-drug interactions. Nonetheless, escitalopram was perceived to have the lowest, while fluvoxamine was perceived to have the highest number of contra-indications. Duration of action: There is no set difference between the duration of action of the 5 drugs under study, although, according to secondary research, 1/3rd of the total therapeutic effect at six weeks was apparent by the 1^st week of treatment. Also, fluoxetine has the highest half-life at 2-4 days, while that of paroxetine is the least, at 16 hours. Yet, based on the study, Sertraline was perceived to have the highest duration of action. Demographics: Although there was no literature found to back this bias, Sertraline was the most preferred drug for us in geriatric patients, while Paroxetine was the least preferred. For adolescent populations, Paroxetine was the most preferred and Fluoxetine was the least preferred. Conclusion: There exists a gap between the theoretical evidence and the practical observations about the pharmacokinetics, uses and side effects of the 5 SSRIs under study. For example, sertraline, a drug proven to be useful in the treatment of depression, has an incorrect bias of causing anxiety as a side effect. This results in psychiatrists not prescribing an effective drug due to a bias with no theoretical basis, thus resulting in poorer treatment outcomes for the patient. For healthcare organizations, it means that they are losing out on almost half the potential patient population. Therefore, it would be useful for them to undertake communication campaigns that revolved around thwarting such biases, thus resulting in better treatment choices for patients and improved health outcomes.