Prescription trends

Prescription trends of antidepressants and antimanic agents vary across countries, and recent research by Datamonitor (in Strategic Perspective: Antidepressants, published in 2001) argues that patients fail to meet treatment criteria by as much as 48% in Europe, 43% in the US, and 15% in Japan.77 The latter can be accounted for by the relatively slow progression of the Japanese antidepressant market in comparison to other markets. Second-generation antidepressants were only launched in Japan in 1999, over a decade after other comparable markets. The fact that SSRIs and other second-generation antidepressants are superior to the older antidepressants, such as TCAs, has raised physicians' expectations of the newer agents. In Japan, the influence of paroxetine (2), fluvoxamine (3), and milinacipran (4) has yet to be fully felt, so physician expectation is modest resulting in physicians being comfortable with current prescribing habits.77 Similar arguments exist for the treatment for BPAD, where the newer atypical antipsychotic agents, anticonvulsants, and gabapentin (5) have yet to establish themselves as first-line therapy over the gold standard, lithium.77

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