Psychiatry - December 2008 - (Page 15)

[trend watch] 26% FIGURE 1. Specialty mix for prescribers of antidepressants Source: SDI Health VONA, Antidepressants June, July, August 2008. FIGURE 2. Therapeutic class mix by specialty; KEY: PCP=primary care physician, Psych=psychiatrist, Ob/Gyn=obstetrician/gynecologist Source: SDI Health VONA, Antidepressants June, July, August 2008. METHODS We obtained data on total retail prescriptions for antidepressant medications in June, July, and August of 2008 from SDI/Verispan’s Vector One National (VONA), which captures nearly half of all prescription activity in the US. desvenlafaxine than either group: 0.4 percent of total antidepressant prescriptions. EXPERT COMMENTARY by Uriel Halbreich, MD RESULTS Over the past quarter, only three percent of antidepressants were prescribed by OB/GYNs (Figure 1). PCPs account for 51 percent of antidepressants prescribed and psychiatrists for an additional 20 percent. Figure 2 displays the mix of therapeutic classes prescribed by physician specialty. As seen in Figure 2, OB/GYNs more frequently prescribe SSRIs (69%) relative to PCPs (58%) and psychiatrists (48%). With respect to individual SSRI selection, OB/GYNs are more likely to prescribe an agent indicated for the treatment of PMDD (e.g., fluoxetine, paroxetine, sertraline): 66 percent versus 59 percent for both PCPs and psychiatrists. Use of desvenlafaxine was slightly elevated in OB/GYNs as compared to PCPs (0.3% vs. 0.1% of total antidepressants, respectively); however, psychiatrists prescribed more Premenstrual syndromes (PMS) and PMDD are interdisciplinary disorders that present with diversified clusters of symptoms. Women sufferers may seek treatment with their PCP, OB/GYN, or psychiatrist. Not surprisingly, the data from SDI/Verispan’s VONA confirm that the woman-patient’s entry point to the medical healthcare system substantially influenced the treatment prescribed to her. While a psychiatrist and a PCP would probably prescribe an antidepressant as the first line of treatment for PMDD, an OB/GYN would very rarely prescribe antidepressants. Though the VONA data presented here do not specify it, it is plausible that OB/GYNs would prescribe more hormonal interventions, mostly oral contraceptives (OC), which are widely used, with at least one OC having an indication for PMDD. So far, none of the medications indicated for PMDD have been shown to be effective for more than 60 percent of women sufferers. The [VOLUME 5, reasons for this efficacy ceiling are intriguing and should be addressed. The main reason for the relatively weak response rate is probably the lack of precise, widely accepted, multidisciplinary, diagnostic criteria. This leaves much flexibility to the practitioner to prescribe according to his or her clinical orientation, beliefs, and traditions, as opposed to prescribing based on evidence. The lack of accepted knowledge on syndromal subgroups of PMS further contributes to imprecise treatments. Hopefully these issues will be rectified in the near future. AUTHOR AFFILIATIONS: Ms. Cascade is Vice President, Quintiles Inc./iGuard, Falls Church, Virginia; Dr. Kalali is Vice President, Global Therapeutic Group Leader CNS, Quintiles Inc., San Diego, California, and Professor of Psychiatry, University of California, San Diego; and Dr. Halbreich is Director, Biobehavior Research, Professor of Psychiatry and OB/GYN, SUNY AB, WPA Section on Interdisciplinary Collaboration, Buffalo, New York. ADDRESS CORRESPONDENCE TO: Ms. Elisa Cascade, Vice President, Quintiles, Inc./iGuard, 3130 Fairview Park Drive, Suite 501, Falls Church, VA 22042; E-mail: elisa.cascade@quintiles.com NUMBER 12, DECEMBER] Psychiatry 2008 15

Table of Contents Feed for the Digital Edition of Psychiatry - December 2008

Psychiatry - December 2008 Editor’s Message Contents Editorial Advisory Board Antidepressant Prescribing by Specialty and Treatment of Premenstrual Dysmorphic Disorder Pain, Pain, Go Away: Antidepressants and Pain Management Why Psychotherapy Helps the Patient in Chronic Pain General Medical Drugs Associated with Depression Katatonia: A New Conceptual Understanding of Catatonia and a New Rating Scale Thermoregulation and the Role of Calcium Signalling in Neurotransmission Cognition and Schizophrenia: Is There a Role for Cognitive Assessments in Diagnosis and Treatment? Journal Watch Information for Authors

Psychiatry - December 2008

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