A cross-sectional, multi-centric, non-interventional study to understand the management practices of major depressive disorder in India (DMI: Depression Management in India)
Abstract
Objective: To study clinical presentation of patients with depression and management practices for major depressive disorder (MDD) by healthcare practitioners (HCPs) in India.
Material and Methods: In a multi-centre, cross-sectional registry, healthcare practitioners opined about the clinical presentation of patients with depression and management practices for MDD. Physician’s opinion on the efficacy and tolerability of antidepressants was graded on a four-point rating scale (1 = Excellent, 2 = Good, 3 = Average and 4 = Poor) and adverse events were recorded.
Results: Data of 1048 patients with mean age of 42.83 years (n = 1048; M:F ratio 7:3) was analysed. Comorbid medical illness in the form of cardiovascular disease, diabetes, osteoarthritis and musculoskeletal diseases were present in 40.60%, 8.15%, 6.18% and 4.99% patients respectively, while alcohol consumption/ substance abuse and smoking history was present in 14.72% and 12.75% patients respectively. Depressed mood most of the day (69.65%) was the most common clinical presentation. Counselling was most commonly (50.48%) practiced non-pharmacological treatment by HCPs. In the pharmacological management, selective serotonin reuptake inhibitors (SSRIs) (73.56%) were the most commonly prescribed medicines. Escitalopram was preferred as monotherapy in 78.04% patients and rated to have “good to excellent” efficacy and tolerability in 99.45% patients. Dizziness, sexual dysfunction, nausea, sedation and insomnia were reported in 4.96%, 2.29%, 1.72%, 1.15%, 1.05% patients respectively.
Conclusion: Many patients with depression have co-morbid medical illnesses. SSRIs are the most commonly prescribed antidepressants for the management of depression. Most of the patients are treated with monotherapy and escitalopram is the preferred monotherapy in most patients with depression.
References
2. Grover S, Dutt A, Avasthi A. An overview of Indian research in depression. Indian J Psychiatry. 2010;52 (Suppl 1): S178-S188
3. Memon A, Patel K. Drug use pattern of antidepressant agents in psychiatric patients – A prospective study. NHL Journal of Medical Sciences. 2013;2:33-36
4. Ray S, Chogtu B. Prescribing Trends in Depression: A drug utilization study done at a tertiary healthcare centre. Journal of Clinical and Diagnostic Research. 2011; 5: 573-577
5. Piccinelli M, Wilkinson G. Gender differences in depression. The British Journal of Psychiatry. 2000, 177 (6) 486-492
6. Poongothai S, Pradeepa R, Ganesan A, Mohan V. Prevalence of depression in a large urban South Indian population--the Chennai Urban Rural Epidemiology Study (CURES-70). PLoS One. 2009 28; 4(9):e7185.
7. Rao AV, Nammalvar N. Death orientation in depression. Indian J Psychiatry. 1979;22:199–205.
8. Venkoba Rao A. Affective illness in first degree relatives, Parental loss and family jointness in depressive disorders. Br J Psychiatry. 1973;122:601
9. Bhugra D, Gupta KR, Wright B. Depression in North India comparison of symptoms and life events with other patient groups. Int J Psychiatry ClinPrac. 1997;1:83–7
10. Hämäläinen J, Kaprio J, Isometsa E, Heikkinen M, Poikolainen K, Lindeman S et al. Cigarette smoking, alcohol intoxication and major depressive episode in a representative population sample. J Epidemiol Community Health. 2001;55:573–576
11. Colvin A, Richardson GA, Cyranowski JM, Youk A, Bromberger JT. Does family history of depression predict major depression in midlife women? Study of Women’s Health Across the Nation Mental Health Study (SWAN MHS). Arch Womens Ment Health. 2014;17:269-78
12. Uzun S, Kozumplik O, Topic R, Jakovljevic M. Depressive disorders and comorbidity: Somatic illness vs side effect. Psychiatria Danubina. 2009; 21: 391–398
13. Scherrer JF, Xian H, Bucholz KK, Eisen SA, Lyons MJ, Goldberg J et al. A twin study of depression symptoms, hypertension, and heart disease in middle-aged men. Psychosom Med. 2003;65:548-57
14. Gehlawat P, Gupta R, Rajput R, Gahlan D, Gehlawat VK. Diabetes with comorbid depression: Role of SSRI in better glycemic control. Asian Journal of Psychiatry. 2013;6:364-368
15. Gloaguen V, Cottraux J, Cucherat M, Blackburn IM. A metaanalysis of the effects of cognitive therapy in depressed patients. J Affect Disord. 1998;49(1):59-72.
16. Park SC, Oh HS, Oh DH, Jung SA, Na KS, Lee HY et al. Evidence-based, non-pharmacological treatment guideline for depression in Korea. J Korean Med Sci. 2014; 29: 12-22
17. Adams SM, Miller KE, Zylstra RG. Pharmacologic Management of Adult Depression. Am Fam Physician. 2008;77(6):785-792, 795- 796
18. Goodnick PJ. Use of antidepressants in treatment of comorbid diabetes mellitus and depression as well as in diabetic neuropathy. Ann Clin Psychiatry. 2001;13:31-41
19. Roose SP, Laghrissi-Thode F, Kennedy JS, et al. Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart disease. JAMA. 1998;279(4):287-291.
20. Bobo WV, Chen H, Trivedi MH, Stewart JW, Nierenberg AA, Fava M et al. Randomized comparison of selective serotonin reuptake inhibitor (escitalopram) monotherapy and antidepressant
combination pharmacotherapy for major depressive disorder with melancholic features: a CO-MED report. J Affect Disord. 2011;133:467-76
21. Papakostas GI. Tolerability of modern antidepressants. J Clin Psychiatry. 2008;69 Suppl E 1:8-13
22. Uher R, Farmer A, Henigsberg N, Rietschel M, Mors O, Maier W et al. Adverse reactions to antidepressants. British Journal of Psychiatry. 2009, 195:202-210
23. Ferguson JM. SSRI Antidepressant medications:Adverse effects and tolerability. Primary Care Companion. J Clin Psychiatry. 2001;3:22-27
24. Kennedy SH, Andersen HF, Lam RW.Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine XR: a meta-analysis. Psychiatry Neurosci. 2006;31:122-31.
