Drug utilization pattern and conformity with who prescribing indicators and Nigerian standard treatment guidelines in patients with major depressive disorder

Abstract

Changes in the utilization patterns of antidepressants have been noticed worldwide, with tricyclic antidepressants and monoamine oxidase inhibitors being gradually replaced by selective serotonin reuptake inhibitors (SSRI) and newer antidepressants. The aim of this study was to assess drug utilization pattern and conformity with WHO prescribing indicators and 2^nd edition of Nigerian Standard Treatment Guidelines (STG) in patients with major depressive disorder. A five-year (1^st January 2014 - 31^st December 2018) retrospective study of 615 prescriptions of patients with major depressive disorder attending Federal Neuro-Psychiatric Hospital Maiduguri was carried out from March to early April 2019. A data collection form was used to obtain drug information and conformity with WHO prescribing indicators and STG. Data were analysed using SPSS version 20. Results were presented as percentages and mean ± SD. The most common prescribed regimen for the management of depression was amitriptyline (a tricyclic antidepressant), which accounted for 305 (49.6%) prescriptions. These regimens were the least expensive drugs with an average daily cost of ₦ 31.4 ± 9.5. Only few prescriptions contained SSRI as follows: 30 (4.9 %), 15 (2.4%) and 50 (8.1%) of escitalopram, paroxetine and fluoxetine, respectively. Also, 89.4% of the antidepressants prescribed were from the 6^th edition of Nigerian National Essential Medicines List, while 88.6 % were from the 2^nd edition of the Nigerian STG. In conclusion, the most commonly prescribed antidepressants class were the tricyclics; particularly amitriptyline. This class also had the least average daily cost (approximately ₦ 31.00 for amitriptyline). Almost all of the antidepressants prescribed for these patients conformed to written recommendations in the WHO prescribing indicators and the 2^nd edition of Nigerian STG.