The treatment of Depressive Disorders in patients with chronic comorbid disease states warrants careful consideration of the risk-benefit ratio pertaining to the pharmacokinetic and pharmacodynamic characteristics of the antidepressant being considered, against the physiological susceptibilities of the patient; potential drug-drug interactions and depressive symptoms. The primary aim of this study was to investigate the relationship between Depressive Disorders and the most frequently diagnosed chronic comorbid disease states in a depressed South African study population; and to comment on the appropriateness of antidepressants prescribed to these patients. This retrospective drug utilisation study consisted of two parts: the first part focused on the prevalence of the most frequently diagnosed chronic comorbidities in a depressed South African population (N = 21 171). The three most prevalent chronic comorbid disease states were Hypertension (52.87 percent), Lipid Disorders (20.40 percent) and Arthritis (16.70 percent). The second part of the study included an assessment of the antidepressants prescribed to depressed patients in 2004 (N = 6 150). Emphasis was placed on the suitability of antidepressants selected for depressed adult patients (18 years of age and older) with comorbid Hypertension, Lipid Disorders or Arthritis. SSRIs were prescribed most frequently to the depressed patients during 2004 (59.67 percent). SSRIs are the suggested first-line treatments for depressed patients with multiple chronic comorbid disease states. However, of the SSRIs, fluoxetine has the least favourable pharmacokinetic profile and was found to be the antidepressant prescribed most often. Amitriptyline, which was the TCA prescribed most frequently, produces the greatest degree of anticholinergic, sedative and hypotensive effects, relative to other agents in the same antidepressant class. Thus, it is not recommended as a first-line antidepressant, especially in depressed patients with comorbidities. This study identifies potential areas of intervention regarding antidepressant prescribing in depressed individuals with chronic comorbid disease states and offers recommendations to promote the selection of optimal, individualised drug treatment strategies for these patients.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:nmmu/vital:10151 |
| Date | January 2007 |
| Creators | Kritiotis, Lia Costas |
| Publisher | Nelson Mandela Metropolitan University, Faculty of Health Sciences |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis, Masters, MSc |
| Format | xxv, 398 leaves ; 30 cm, pdf |
| Rights | Nelson Mandela Metropolitan University |
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