Prescription For Depression Research Articles

Remote Instruction and Student Mental Health: Swedish Evidence from the Pandemic

When COVID-19 reached Sweden, upper-secondary students (ages 17–19) transitioned to remote instruction, while lower-secondary schools (ages 14–16) remained open. We use this setting as a natural experiment to analyze how modes of instruction affect student mental health. We find a 4.4 percent decrease in mental health care use from remote instruction, primarily due to fewer diagnoses and prescriptions for depression and anxiety. The reduction persists throughout the study period; 21 months after the initial closure and 9 months after schools resumed usual operations. This suggests potential mental health benefits from remote instruction, at least in the medium term. (JEL I12, I18, I21, I28, I31)

Changes in Children and Youth's Mental Health Presentations during COVID-19: A Study of Primary Care Practices in Northern Ontario, Canada.

Recent research suggests that children and youth are at increased risk of anxiety and depression due to the indirect effects of the COVID-19 pandemic. In Canada, children and youths may face additional hurdles in accessing mental health services in rural areas due to socioeconomic disadvantages and healthcare provider shortages worsened by the pandemic. Our study aimed to assess changes in primary healthcare utilization related to depression and anxiety among children and youth aged 10-25 years in Northern Ontario, Canada. We analyzed de-identified electronic medical record data to assess primary healthcare visits and prescriptions for depression and anxiety among children and youth aged 10-25 years. We used provider billing data and reasons for visits and antidepressant/antianxiety prescriptions compared with 21 months pre-pandemic (1 June 2018 to 28 February 2020) and 21 months during the pandemic (1 April 2020 to 31 December 2021). Our interrupted time series analysis showed an average increase in visits by 2.52 per 10,000 person-months and in prescriptions by 6.69 per 10,000 person-months across all ages and sexes. Females aged 10 to 14 years were found to have the greatest relative change in visits across all age-sex groups. The greatest relative increases in antianxiety and antidepression prescriptions occurred among females and males aged 10 to 14 years, respectively. These findings indicate that there were increased anxiety and depression presentations in primary healthcare among children and youths living in northern and rural settings during the COVID-19 pandemic. The increased primary healthcare presentations of anxiety and depression by children and youths suggest that additional mental health resources should be allocated to northern rural primary healthcare to support the increased demand. Adequate mental health professionals, accessible services, and clinical recommendations tailored to northern rural populations and care settings are crucial.

Lifestyle Prescription for Depression with a Focus on Nature Exposure and Screen Time: A Narrative Review.

Recent lifestyles changes have favored increased time in contact with screens and a parallel reduction in contact with natural environments. There is growing awareness that nature exposure and screen time are related to depression. So far, the roles of how these environmental lifestyles affect depressive symptoms and disorders have not been reviewed simultaneously. The aim of this review was to gather the literature regarding the role of nature exposure and screen time in depression. An emphasis was made on clinical samples of patients with well-defined depression and the different methodological approaches used in the field. A second goal was to suggest an agenda for clinical practice and research. Studies were included if they assessed depressive symptoms in patients with a clinical diagnosis of depression. An overview of the published literature was conducted using three scientific databases up to December 2021. Several interventions involving nature exposure have shown positive effects on depressive symptoms and mood-related measures. The most consistent finding suggests that walks in natural environments may decrease depressive symptoms in patients with clinical depression. Less researched interventions, such as psychotherapy delivered in a forest or access to natural environments via virtual reality, may also be effective. In contrast, fewer observational studies and no experimental research on screen time have been conducted in patients with clinical depression. Thus, recommendations for practice and research are also discussed. Scarce research, diverse interventions, and several methodological shortcomings prevent us from drawing conclusions in this area. More high-quality experimental research is needed to establish interventions with proven efficacy in clinical depression. At this stage, it is too early to formulate practice guidelines and advise the prescription of these lifestyles to individuals with depression. The present findings may serve as a basis to develop strategies based on nature exposure and screen time targeting clinical depression.

Creating an e-cohort of unpaid carers and understanding their mental health needs in Wales: a data linkage study

BackgroundDespite the contribution of unpaid carers to society in Wales, there is a lack of understanding of the true extent of unpaid carers, no routinely available data to understand the impact of caring on their own health and wellbeing, nor the longer-term effect on educational outcomes and employment perspectives. Such information is needed to help inform actions to reduce the harms within the Welsh Government's recovery plan, Leading Wales Out of the Coronavirus Pandemic, and also to inform the aspirations within the national Well-being of Future Generations (Wales) Act and the Social Services and Well Being (Wales) Act 2014. We aimed to identify an e-cohort of unpaid carers through routine health and administrative data in Wales. MethodsWe validated a list of Read Codes to identify individuals recorded as unpaid carers in Wales who accessed NHS primary care services since Jan 1, 2010 until Oct 10, 2020, from the Welsh Longitudinal General Practice Dataset in the Secure Anonymised Information Linkage (SAIL) Databank. We then linked the e-cohort with primary care records to identify entries, diagnoses, or prescriptions for depression or anxiety symptoms within 1 year before they first appeared in the e-cohort. This study is exempt from consent due to the anonymised nature of the databank. The independent Information Governance Review Panel approved this study. Findings68 457 unpaid carers were identified via the initial scan and 94% (n=64 656) of those had full demographic information. We also included individuals (n=5009) who self-reported as unpaid carers in National Survey for Wales. Of them, 65% (n=41 999) of carers were female and 24% (n=15 581) were aged 55–64 years as of their first appeared in the e-cohort. 1% (n=918) of carers were younger than 16 years and 6% (n=3688) were older than 85 years. At least 9% (n=5646) of the unpaid carers had depression or anxiety, or both, while providing care. InterpretationOur study creates a unique and reproducible e-cohort that enables rapid and better understanding of unpaid carers' health needs in Wales (eg, depression or anxiety). With ongoing work to include more routine datasets, including carers' assessment, it will allow privacy-protected analysis to support initiatives for carers (eg, carers' vaccine uptake during the pandemic). Despite the efforts of pulling together a comprehensive code list, there are systematic differences in recording non-health patient information in practice. FundingThis research was funded through Public Health Wales.

Birth outcomes, pregnancy complications, and postpartum mental health after the 2013 Calgary flood: A difference in difference analysis.

BackgroundIn June 2013, the city of Calgary, Alberta and surrounding areas sustained significant flooding which resulted in large scale evacuations and closure of businesses and schools. Floods can increase stress which may negatively impact perinatal outcomes and mental health, but previous research is inconsistent. The objectives of this study are to examine the impact of the flood on pregnancy health, birth outcomes and postpartum mental health.MethodsLinked administrative data from the province of Alberta were used. Outcomes included preterm birth, small for gestational age, a new diagnoses of preeclampsia or gestational hypertension, and a diagnosis of, or drug prescription for, depression or anxiety. Data were analyzed using a quasi-experimental difference in difference design, comparing flooded and non-flooded areas and in affected and unaffected time periods. Multivariable log binomial regression models were used to estimate risk ratios, adjusted for maternal age. Marginal probabilities for the difference in difference term were used to show the potential effect of the flood.ResultsParticipants included 18,266 nulliparous women for the pregnancy outcomes, and 26,956 women with infants for the mental health analysis. There were no effects for preterm birth (DID 0.00, CI: -0.02, 0.02), small for gestational age (DID 0.00, CI: -0.02, 0.02), or new cases of preeclampsia (DID 0.00, CI: -0.01, 0.01). There was a small increase in new cases of gestational hypertension (DID 0.02, CI: 0.01, 0.03) in flood affected areas. There were no differences in postpartum anxiety or depression prescriptions or diagnoses.ConclusionThe Calgary 2013 flood was associated with a minor increase in gestational hypertension and not other health outcomes. Universal prenatal care and magnitude of the disaster may have minimized impacts of the flood on pregnant women.

Early labor force exits in patients with treatment-resistant depression: an assessment of work years lost in a Danish nationwide register-based cohort study.

Background:Depression is one of the leading causes of premature workforce exit in many Western countries, but little is known about the extent to which treatment-resistance reduces number of work-years. We compared the risk of premature workforce exit among patients with treatment-resistant depression (TRD) relative to non-TRD patients and estimated work years lost (WYL) before scheduled retirement age.Methods:The study population, identified in the Danish National Prescription Registry, included all individuals born and living in Denmark who redeemed their first antidepressant (AD) prescription for depression at age 18–60 years between 2005 and 2012. TRD was defined as failure to respond to at least two different treatment trials. Premature workforce exit was measured using disability pension records. We used Cox regression to estimate the hazard ratio (HR) for premature workforce exit in TRD relative to non-TRD patients, adjusting for calendar year, psychiatric and somatic comorbidity, and educational level. Differences in WYL in patients with TRD and all depression patients were estimated through a competing risks model.Results:Out of the total sample of patients with depression (N = 129,945), 7478 (5.75%) were classified as having TRD. During follow up, 17% of patients with TRD and 8% of non-TRD patients received disability pension, resulting in a greater than three-fold larger risk of premature workforce exit [adjusted HR (aHR) 3.23 95% confidence interval (CI) 3.05–3.43]. The TRD group lost on average six work-years (95% CI 5.64–6.47) more than the total sample due to early labor force exit. The association between TRD and age at premature workforce exit was inversely U-shaped; the hazard rate of premature workforce exit for patients with TRD compared with non-TRD patients was highest in the age groups 31–35, 36–40, and 41–45 years.Conclusion:Patients with TRD constitute a small group within depression patients, but contribute disproportionally to societal costs due to premature workforce exit at a young age.

Prevalence and predictors of tricyclic antidepressant use among elderly Koreans in primary-care and specialty clinics.

Tricyclic antidepressants (TCAs) are prescribed with caution in the elderly due to diverse side effects. We analyzed the patterns of TCA use in elderly patients in primary-care and specialty clinics and investigated factors influencing TCA prescriptions. Elderly patients (≥65 years old) prescribed antidepressants in primary-care clinics in 2013 were included from the Health Insurance Review and Assessment Service-Aged Patient Sample (HIRA-APS). Prevalence of TCA prescriptions was assessed by insurance coverage status, clinical specialty, and region. Multiple logistic regression analysis was performed to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with TCA prescriptions. TCAs and selective serotonin reuptake inhibitors (SSRIs) comprised 45.2% and 15.0% of all antidepressant prescriptions, respectively. TCAs comprised 61.5% and 20.7% of antidepressant prescriptions for pain and depression, respectively. Patients aged ≥85 years were less likely to be treated with TCAs (OR 0.81, 95% CI 0.79-0.84) than those aged 65-69 years. The odds for being prescribed TCAs were higher for patients residing in cities (OR 1.20, 95% CI 1.18-1.23), treated in nonpsychiatric clinics (OR 5.64, 95% CI 5.53-5.76), and those covered by Veteran's Health (OR 1.62, 95% CI 1.37-1.90) when compared to patients residing in the Seoul metropolitan area, treated in psychiatric clinics, or covered by National Health Insurance, respectively. The prescriptions of TCAs with pain diagnoses were much higher than prescriptions for depression (OR 1.87, 95%CI 1.82-1.93). Compared with a 2005 report, the prevalence of TCA prescriptions in elderly patients in Korea has decreased substantially, but remains high. Various efforts should be considered to reduce TCA prescriptions in the elderly. .

Evaluation of indoor prescriptions of depression in psychiatry department of a tertiary care hospital in North India

Background: Depression is one of most common psychiatric illnesses affecting the human population and poses significant economic burden to society. Prescription for depression usually involves multiple medications sometime irrationally prescribed.Methods: Present study involved evaluation of 65 indoor prescriptions of patients diagnosed with depression from Psychiatry Department in a tertiary care hospital. The prescriptions were evaluated on basis of WHO Core Indicators for writing a good prescription. The demographic characteristics of the patient population were studied. Number of drugs prescribed per prescription and the average number per prescription were calculated to assess polypharmacy. The cost involved in treatment using latest market data from drug information source and the rationality of prescriptions were also evaluated.Results: 80% of the prescriptions were not in accordance with the WHO Core Indicators. An average of 2.415±1.102 medications were prescribed per prescription indicating polypharmacy. Insignificant difference was observed in cost per prescription per month of medicines when compared with lowest priced products available in market.Conclusions: Polypharmacy was found in most prescriptions and monotherapy was instituted in five prescriptions only, with clonazepam as the most prescribed antidepressant drug. Majority of prescriptions did not conform to WHO core indicators for prescription writing.

Older Adults Are More Likely to Receive Prescriptions for Depression, Anxiety

Per capita, adults aged 65 and over were prescribed these medications at around twice the rate of younger adults. Seniors also received fewer psychotherapy visits on average.

PMH60 - Audit of irreversible Monoamine Oxidase Inhibitors (MAOI) prescription for depression in current Clinical practice within the Health improvement Network (THIN) UK primary care database

MAOIs were first discovered in the 1950s and used to manage depression when few alternatives existed. MAOIs block tyramine catabolism, meaning patients consuming tyramine rich foods (e.g. cheeses, cured meats) risk increased release of noradrenaline, potentially leading to hypertensive crisis. While MAOIs still have some role in depression management, little is known about current clinical practice. This study aims to audit the usage of MAOIs from 2004-2013. The THIN database was used to identify all patients prescribed irreversible MAOIs between 01/01/2004–31/12/2013. Dates of first MAOI prescription and first depression diagnosis were identified, along with age, social deprivation score and repeat MAOI prescriptions. 886 patients were prescribed MAOIs during 2004-2013, 44% of which were new prescriptions. Median age at first use was 53years (IQR 43-63), M:F ratio was 1:1.8 and 49% were in the 2 most affluent quintiles. The median time from first depression diagnosis to first MAOI prescription was 11.2years (IQR 4.3-21.1). From 2004-2013, MAOI usage decreased from 555 to 248 patients, with treatment initiation falling from 72 to 28 patients. Median age of treated patients increased from 63 to 68years and 4-8% had concurrent SSRI prescriptions. Median prescription use was 8.8months (IQR 5.1-11.0) in each year, with per patient prescriptions ranging from 37 (IQR 20-69) to 54 (IQR 27-83). Median time on MAOI from 2004-2013 was 1.7years (IQR 0.4-4.8). THIN is a representative sample of 6% of the UK population. This study projects an estimated 600 UK patients start MAOIs yearly, with numbers decreasing. Estimated UK MAOI usage has fallen from 9,000 to 4,000 patients during 2004-2013. Records indicate that patients are receiving shorter, more frequent prescriptions. NICE guidelines confirm that MAOIs still have some role in depression management, although not defined. This is the first large study to audit changes in MAOI usage.

Severe Neuropsychiatric Outcomes Following Discontinuation of Long-Term Glucocorticoid Therapy

It has been estimated that, at any point in time, about 1% of the general adult population of the United Kingdom is receiving long-term (ie, ≥ 3 months) oral glucocorticoid therapy. These patients may develop neuropsychiatric disorders when the drug is discontinued. Data were obtained for all adult patients registered from January 1, 1990, through December 31, 2008, at UK general practices that were contributors to The Health Improvement Network database. Data from 21,995 adult patients who had been exposed to long-term oral glucocorticoids and who had discontinued the drugs after an exposure ranging from 1 to 3 years were analyzed. The within-person incidence rate ratios (IRRs) for Read codes and/or prescriptions for depression, delirium/confusion, mania, panic disorders, and suicide or suicide attempt during the withdrawal period were estimated using a self-controlled case series methodology. The predictors of the outcomes were ascertained using Cox proportional hazards models. The risk of depression (IRR = 1.13; 95% CI, 1.00-1.28; P = .04) and of delirium/confusion (IRR = 2.67; 95% CI, 1.96-3.63; P < .001) was significantly higher during the discontinuation period compared to a reference period defined as ranging from 5 to 3 months before the drug cessation. Older people were at higher risk of delirium/confusion. The use of long-acting glucocorticoids was associated with a higher risk of both depression (adjusted hazard ratio [HR] = 1.92; 95% CI, 1.07-3.46) and delirium/confusion (adjusted HR = 4.96; 95% CI, 2.60-9.49) during the withdrawal period. Discontinuation of long-term glucocorticoid therapy is associated with an increased risk of both depression and delirium/confusion. People treated with long-acting glucocorticoids are particularly at risk.

Preliminary study of patterns of medication use for depression treatment in China

This systematic review investigated drug utilization for depression and assessed trends in prescriptions in China. Major Western and Chinese electronic databases were searched without language restriction for studies reporting defined daily doses. A total of 76 studies published between 2000 and 2010 reporting data on prescriptions for depression in China between 1996 and 2008 were included. All studies were published in Chinese. Most trials were conducted in urban areas in south and east China. Twenty-nine drugs were reported as antidepressants. On the basis of defined daily doses, melitracen/flupentixol combination, fluoxetine, and paroxetine were the most frequently prescribed compounds. According to published evidence, selective serotonin reuptake inhibitors have become the most commonly prescribed class of antidepressant drugs in China.

Medication prescription for depression in children and adolescents.

Medication prescription for depression in children and adolescents.

Canada Sees Troubling Trend in Antidepressant Prescribing

Canada Sees Troubling Trend in Antidepressant Prescribing

Retrospective review of sex differences in the management of dyslipidemia in coronary heart disease: An analysis of patient data from a Maryland-based health maintenance organization

Background: Coronary heart disease (CHD) is the leading cause of death in men and women in the United States, with a higher mortality in women, despite a lower prevalence. Statins effectively treat dyslipidemia and reduce the risk of CHD mortality. Objective: The objective of this study was to evaluate the treatment of dyslipidemia in patients with CHD and determine if sex differences exist. Methods: This was a retrospective chart review performed within a multioffice staff model health maintenance organization of ∼70,000 members. An administrative database, containing inpatient and out-patient medical claims, was used to identify patients with CHD based on diagnostic codes. Charts were randomly selected and the following information was obtained from chart review: age; sex; risk factors for CHD; diagnosis and/or prescription for depression; blood low-density lipoprotein cholesterol (LDL-C) level; and drug, dosage, and duration of prescribed lipid-lowering therapy. Exclusion criteria included missing charts and unavailable LDL-C values. LDL-C values were classified as at target if LDL-C <2.59 mmol/L (<100 mg/dL). Patients receiving statin monotherapy were categorized into 3 potency groups, based on efficacy to lower LDL-C values: high (atorvastatin 20–80 mg, lovastatin 80 mg), medium (atorvastatin 10 mg, pravastatin 40 mg, simvastatin 200 mg), and low (fluvastatin 10–40 mg, lovastatin 10–40 mg, pravastatin 10–20 mg, simvastatin 5–10 mg). Results: A total of 1487 adult patients (64.4% male with a mean (SD) age of 65.7 (11.8) years were identified, based on diagnostic codes for CHD. Three hundred twenty charts were selected for review. After exclusion, the final study cohort was 290 patients. The cohort was 66.2% male (192/290) with no significant difference in mean (SD) age between men (65.2 [9.2] years) and women (66.9 [10.5] years). Weight of women ranged from 85 to 305 lbs; 134 to 288 lbs for men. Among the study cohort, 46.2% (134/290) of the patients achieved the target LDL-C of <2.59 mmol/L (<100 mg/dL), with significantly more men (51.0% [98/192]) than women (36.7% [36/98]) reaching target ( P = 0.021). Lipid-lowering therapy was prescribed to 68.6% (199/290) of the patients, with no significant sex differences (men, 71.4% [137/192]; women, 63.3% [62/98]). Of the patients prescribed lipid-lowering therapy (primarily statins), 53.8% (107/199) achieved target LDL-C. There was no significant sex difference in the potency groups prescribed, and the rate of LDL-C target attainment was similar across potency groups. Overall, 70.3% of patients who did not receive lipid-lowering therapy had inadequately controlled LDL-C (women, 31/36 [86.1 %]; men, 33/55 [60.0%] [ P = 0.008]). Conclusions: The majority of CHD patients from a Maryland-based health maintenance organization had elevated LDL-C values, despite a lipid-lowering prescription rate of 68.6%. A significant gap in dyslipidemia treatment in these CHD patients remained, particularly for women.

Risk of drug interaction: combination of antidepressants and other drugs.

To assess the frequency of combination of antidepressants with other drugs and risk of drug interactions in the setting public hospital units in Brazil. Prescriptions of all patients admitted to a public hospital from November 1996 to February 1997 were surveyed from the hospital's data processing center in S o Paulo, Brazil. A manual search of case notes of all patients admitted to the psychiatric unit from January 1993 to December 1995 and all patients registered in the affective disorders outpatient clinic in December 1996 was carried out. Patients taking any antidepressant were identified and concomitant use of drugs was checked. By means of a software program (Micromedex ) drug interactions were identified. Out of 6,844 patients admitted to the hospital, 63 (0.9%) used antidepressants and 16 (25.3%) were at risk of drug interaction. Out of 311 patients in the psychiatric unit, 63 (20.2%) used antidepressants and 13 of them (20.6%) were at risk. Out of 87 patients in the affective disorders outpatient clinic, 43 (49.4%) took antidepressants and 7 (16.2%) were at risk. In general, the use of antidepressants was recorded in 169 patients and 36 (21.3%) were at risk of drug interactions. Twenty different forms of combinations at risk of drug interactions were identified: four were classified as mild, 15 moderate and one severe interaction. In the hospital general units the number of drug interactions per patient was higher than in the psychiatric unit; and prescription for depression was lower than expected.

Antidepressant prescription for depression in general practice in The Netherlands.

To evaluate diagnoses and the prescription of antidepressants drugs for depression, based on data from 1993 to 1998 related to consultations for depression in general practice in the Netherlands. An exploratory analysis of data provided by IMS Health. Consecutive annual representative samples of 640 GPs regularly registered data on morbidity and (drug) treatment for specific medical problems in special booklets for a period of one week. The data refer to consultations for depression. The diagnoses were initially based on ICD-9 criteria and later ICD-10 criteria for depression. Number of diagnoses of depression and number of prescriptions for antidepressants. The number of first consultations for depression rose gradually, from 909 in 1993 (95% CI: 774 to 1043), to 1,482 (CI: 1292 to 1672) in 1998: an increase of 63%. For an individual GP, this represents an increase from 18 to 30 in first consultations for depression. The number of prescriptions for antidepressants also increased, mainly during repeat consultations: a 278% increase, from 3,708 in 1993 to 14,024 in 1998 (CIs: 3,504 to 3,912 and 13,252 to 14,796). Antidepressants were prescribed during the first consultation 564 times in 1993 compared with 1,080 times in 1998. The first contact with a GP for depression led to an antidepressant prescription in 62% of cases in 1993 and 73% in 1998. Although the guidelines issued by the Dutch College of General Practitioners in 1994 recommended tricyclic antidepressants (TCAs) for the treatment of depression, paroxetin, fluoxetin, and mirtazapin (SSRIs) accounted for 56% of the prescribed antidepressants. Between 1993 and 1998, GPs in the Netherlands prescribed increasingly more antidepressants, and they prescribed more SSRIs than TCAs. Furthermore, GPs diagnose depression more frequently and the number of repeat consultations has increased.

Survey of new antidepressants in secondary care

INTRODUCTION: There are no conclusive data to support the superior efficacy of any one antidepressant, while costs and side-effects are known to differ. The use of venlafaxine has been observed to be increasing within local services and this is associated with significant cost. This survey examined the patterns of use of new antidepressants by psychiatrists in the UK. METHOD: 188 questionnaires were sent to hospital pharmacists. The doses of fluoxetine, paroxetine, sertraline and venlafaxine used for the treatment of depression over a 1-week census period were recorded, together with the total quantities of each drug supplied by hospital pharmacies in the financial year 1997/1998. RESULTS: 84 completed replies were received (45%), with a total number of 2060 prescriptions for depression, making this the largest survey to date of antidepressant prescribing by psychiatrists. Fluoxetine and paroxetine were associated with less dosage titration and cost less per treatment month than sertraline and venlafaxine. CONCLUSION: Venlafaxine has not been consistently proven to be more effective than other antidepressants and is more costly, yet its use by psychiatrists is increasing nationally. Comparative data such as these are not routinely available for hospital care in the UK. The new NHS will bring more demand for such data and more accountability for its content. (Int J Psych Clin Pract 2000; 4:105-109)

Inadequate dosaging in general practice of tricyclic vs. other antidepressants for depression.

Several prescription database studies suggest major differences between antidepressants in the proportion of patients in general practice treated with doses likely to elicit a true drug response. However, in these studies it has been difficult to differentiate prescriptions for depression from those for other indications, or to distinguish lower starting doses from the final treatment doses. We investigated possible differences between types of antidepressant in the proportions of patients receiving adequate treatment doses for depression from the primary health care services of Helsinki. Doctors at 22 (71%) of the 31 health centres in Helsinki were surveyed with regard to their antidepressant prescriptions over a period of 2 working weeks. There were marked differences in dosaging adequacy between the various types of antidepressant prescribed for depression at final treatment doses. Overall, 71% of the prescriptions for the tricyclic antidepressants, but only 13% of those for the other antidepressants, mainly selective serotonin reuptake inhibitors, were for low doses that are generally considered to be ineffective (P<0.001). These findings endorse the emerging perception that, in general practice, tricyclic antidepressants are usually prescribed for depression in too low doses, and that a greater reliance on other antidepressants would probably improve the effectiveness of treatment in primary health care.

Sleep patterns scrutinized as depression therapy

EARLY TO BED, early to rise, may be the new prescription for depression. Twenty-two years ago, quite by chance, psychiatrists discovered that a night without sleep sometimes cured depression. Since then, more than 1000 patients have been subjected to total sleep deprivation; 70% of those with bipolar depression and 60% of those with unipolar depression respond to the treatment (<i>Prog Neuropsychopharmacol Biol Psychiatry</i>1983;7:351-364). While the effect is immediate (unlike that of antidepressant drugs), it is also short-lived. Relapse typically occurs following a night of recovery sleep. But evidence is accumulating to suggest that partial sleep deprivation—if it occurs at the right time of the night— can exert an effective and lasting benefit to depressed persons (<i>Arch Gen Psychiatry</i>1980;37:267-271). This may open the way for a simple and far more tolerable therapy, even in those patients who do not respond to drugs, and narrow the search for the mechanisms