Abstract
The aim of the study was to examine the patterns of antidepressant use in Estonia on different levels. In 1996 the total utilization of antidepressants in Estonia was 2.69DDD/1000/day, more than 10-fold lower than in Nordic countries. The tricyclic antidepressants (TCAs) accounted for 77% (2.08DDD/1000/day) of the antidepressant utilization. The pattern of antidepressant use in Estonia was also more restrictive, as the top five individual antidepressants in Estonia gave 96% of total utilization, in contrast to 78% in Finland. In Lääne-Virumaa County (76,007 inhabitants) 1995 prescriptions for antidepressants were identified during 1996. Psychiatrists prescribed less TCAs than other physicians: 44% and 57% of all antidepressant prescriptions, respectively. The share of selective serotonin reuptake inhibitor (SSRI) prescriptions was similar both for psychiatrists and non-psychiatrists, accounting for 38%-40%. Forty per cent of the prescriptions were prescribed for treatment of diseases other than depression. In Tartu University Psychiatry Hospital 18% of 200 randomly selected outpatients were treated by intravenous injection. The most popular antidepressants in the treatment of outpatients were amitriptyline, nortriptyline, and citalopram. Analysis of the case records of 200 randomly selected inpatients showed that 43% of inpatients were treated by intravenous infusion, 19% by intravenous injection, and 26% by intramuscular administration of antidepressants. Seventy-five per cent of inpatients and 34% of outpatients were treated with various combinations of psychotropic drugs. The most popular combination was a benzodiazepine with a tricyclic. The most popular antidepressants in the treatment of inpatients were amitriptylline, imipramine, and nortriptyline. In conclusion, the utilization of antidepressants in Estonia was significantly lower than that in the Nordic countries (Finland, Sweden, and Norway) and is indirect evidence of underdiagnosis and undertreatment of depressive disorders in Estonia.
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