A study on prevalence and pattern of antipsychotic use in depression in a tertiary care hospital in North India

OBJECTIVE: Depressive disorders are leading cause of disability worldwide.Though antidepressants remain mainstay of treatment, antipsychotics have long been used in treatment of depressive disorders due to their antipsychotic, antidepressant, anxiolytic and sedative-hypnotic properties. To date, US-FDA has approved aripiprazole and quetiapine as adjunctive treatment for depressive disorders, and combination of olanzapine and fluoxetine for treatment of treatment-resistant depression. Antipsychotics are also used off- label in Depression for indication and dosages other than US-FDA approved. However, extent and pattern of such use has not been studied much in North India. The purpose of this study is to investigate the prevalence and pattern of prescription of antipsychotics in depressive disorders and to determine whether it is approved indication or not. METHODS: This study included 400 consecutive patients attending OPD of a tertiary care hospital in North India. In those with diagnosis of Depression (F-32and F-33), socio-demographic,clinical data, prevalence, type and dosage of antipsychotic medication and whether their usage is FDA approved or not was analysed. RESULTS: Depressed patients comprised of 36 %(n=144/400) of sample. In patients with diagnosis of depression 66.7%(n=96/144) received antipsychotics,75%(n=72) received single antipsychotic and 25% (n=24) received more than one antipsychotic. Olanzapine was most commonly used antipsychotic (41%), followed by Quetiapine(35%), Aripiprazole(10%), Trifluoperazine(6%), Risperidone(5%) and Chlorpromazine(3%). Mean doses(mg) used were- Olanzapine-6.25, Quetiapine- 82.14, Aripiprazole- 5, Trifluoperazine- 5, Chlorpromazine-100 and Risperidone-2. 55% of the prescriptions of Depression had antipsychotic prescribed according to USFDA approved indication whereas 45% were off-label prescriptions. CONCLUSION: Antipsychotics are commonly prescribed in depressive disorders and are often used to treat associated multidimensional symptoms in these disorders. However, they should be prescribed only after weighing risks and benefits since there is insufficient evidence on the efficacy and safety for most off-label applications of antipsychotics.