Conventional antipsychotic prescription in unipolar depression, I: an audit and recommendations for practice

BACKGROUND: Despite narrow indications for conventional antipsychotics in depression, recent reports confirm a suspicion that they are widely prescribed in nonpsychotic depressive conditions.

METHOD: Data from the case notes of over 510 patients with unipolar depression (unvalidated clinical diagnoses) were collected between June 1997 and January 1998 from community and acute units in 1 National Health Service (NHS) Trust. The aim of this audit was to assess the extent and pattern of antipsychotic prescription in this sample.

RESULTS: More than a quarter (N = 138) of the sample (N = 494) were currently prescribed an antipsychotic; 40% of these received an antipsychotic without any recognized indication. The mean time on antipsychotic therapy was 3 years. Patients on antipsychotic therapy were, on average, taking twice as many total medications as those not on antipsychotic therapy. Patients with psychotic depression were taking an average of nearly twice the antipsychotic dose of nonpsychotic patients.

CONCLUSION: Current clinical guidelines commend careful antidepressant choice in preference to polypharmacy. A number of drug choices for specific depressive presentations are summarized from recent sources.