Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects

Stuti Mittal; Haresh Raulgaonkar

doi:doi:10.11648/j.ijber.20190803.13

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Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects

Stuti Mittal, Haresh Raulgaonkar

Published in International Journal of Business and Economics Research (Volume 8, Issue 3)

Received: 3 March 2019 Accepted: 31 May 2019 Published: 12 June 2019

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Abstract

Objective: To study the biases in the prescription of Selective Serotonin Reuptake Inhibitors and the variation between the literature and the perception of doctors prescribing SSRIs. Methodology: The five drugs under study were sertraline, fluoxetine, fluvoxamine, paroxetine, escitalopram. The factors influencing the psychiatrist’s perceptions/ practice considered in this study are: A) Pharmacokinetic factors of the drug (Contra indications, Drug efficacy, Onset of action, Duration of action and the Bioavailability) B) Uses of the drug (for Social Anxiety Disorder, Generalized Anxiety Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder and Post-Traumatic Stress Disorder) C) Side effects (Somnolence, Anxiety, Tremors, Anorexia and sexual dysfunction) D) Patient’s Demographics (Gender, Age group, Special Groups- Geriatrics and Adolescents) E) Commercial aspects (Retail Price, Availability, Brand Value of the Parent Brand and Interpersonal Skills of the Medical Representative). Discussion: Contra-Indications: Theoretically, all SSRIs have the same number of contra-indications, since they have the same mechanism of action, though fluoxetine and paroxetine have a relatively higher potential of drug-drug interactions. Nonetheless, escitalopram was perceived to have the lowest, while fluvoxamine was perceived to have the highest number of contra-indications. Duration of action: There is no set difference between the duration of action of the 5 drugs under study, although, according to secondary research, 1/3rd of the total therapeutic effect at six weeks was apparent by the 1^st week of treatment. Also, fluoxetine has the highest half-life at 2-4 days, while that of paroxetine is the least, at 16 hours. Yet, based on the study, Sertraline was perceived to have the highest duration of action. Demographics: Although there was no literature found to back this bias, Sertraline was the most preferred drug for us in geriatric patients, while Paroxetine was the least preferred. For adolescent populations, Paroxetine was the most preferred and Fluoxetine was the least preferred. Conclusion: There exists a gap between the theoretical evidence and the practical observations about the pharmacokinetics, uses and side effects of the 5 SSRIs under study. For example, sertraline, a drug proven to be useful in the treatment of depression, has an incorrect bias of causing anxiety as a side effect. This results in psychiatrists not prescribing an effective drug due to a bias with no theoretical basis, thus resulting in poorer treatment outcomes for the patient. For healthcare organizations, it means that they are losing out on almost half the potential patient population. Therefore, it would be useful for them to undertake communication campaigns that revolved around thwarting such biases, thus resulting in better treatment choices for patients and improved health outcomes.

Published in	International Journal of Business and Economics Research (Volume 8, Issue 3)
DOI	10.11648/j.ijber.20190803.13
Page(s)	97-107
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Antidepressants, Selective Serotonin Reuptake Inhibitor, Pharmacokinetics of SSRIs

References

[1]	(n. d.). Retrieved Novemeber 19th, 2018, from Depression statistics WHO India: http://www.searo.who.int/india/topics/depression/en/.
[2]	Nutt, D. J. (2005, Jan). Overview of Diagnosis and Drug Treatments of Anxiety Disorders. CNS Spectums, 10 (1), 49-56.
[3]	Sheehan, D. V. (2006). Assessing Remission In Major Depressive Disorder And Generalized Anxiety Disorder Clinical Trials With The Discan Metric Of The Sheehan Disability Scale. . International Clinical Pharmacology.
[4]	Renoir, T. (2013). Selective Serotonin Reuptake Inhibitor Antidepressant Treatment Discontinuation Syndrome: A Review Of The Clinical Evidence And The Possible Mechanisms Involved. Frontiers In Pharmacology.
[5]	Tyler, M. F. (2006). Early Onset Of SSRI Antidepressant Action. . Europe PMC Funders Group.
[6]	Harten, J. V. (1993, March). Clinical Pharmacokinetics Of SSRIs. Clinical Pharmacokinetics, 24 (3), 203-220.
[7]	Andre Tylee, P. W. (2007). Onset of action of antidepressants. British Medicine Journal, 334-911.
[8]	Ferguson, J. (2001, February). SSRI Antidepressant Medications: Adverse Effects And Tolerability. The Primary Care Companion To The Journal Of Clinical Psychiatry., 3 (1), 22-27.
[9]	Trivedi, J. K. (2010). Antidepressant Drug Prescription Patterns For Depression At A Tertiary Health Care Centre Of Northern India. Medical Practice And Review.
[10]	Marco Piccinelli, G. W. (2000, December). Gender differences in depression: Critical review. The British Journal of Psychiatry, 177 (6).
[11]	Marken P, M. (2000, ecember). Selecting A Selective Serotonin Reuptake Inhibitor: Clinically Important Distinguishing Factors. The Journal Of Clinical Psychiatry, 2 (6), 205-210.
[12]	Cohen, D. (2007). Should The Use Of SSRIs In Child And Adolescent Depression Be Banned? . Psychotherapy And Psychosomatics., 76 (1), 5-14.
[13]	Sanchez, C. R. (2014, July). A Comparative Review Of Escitalopram, Paroxetine, And Sertraline: Are They All Alike? . International Clinical Psychopharmacology., 24 (5), 185-196.
[14]	Huskamp, H. D. (2003, August). Pharmacoeconomics. . 26 (7), 603-616.
[15]	List of Essential Medicines from WHO. (2015). Retrieved from http://apps.who.int/medicinedocs/en/m/abstract/Js23088en/.

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Stuti Mittal, Haresh Raulgaonkar. (2019). Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects. International Journal of Business and Economics Research, 8(3), 97-107. https://doi.org/10.11648/j.ijber.20190803.13

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Stuti Mittal; Haresh Raulgaonkar. Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects. Int. J. Bus. Econ. Res. 2019, 8(3), 97-107. doi: 10.11648/j.ijber.20190803.13

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Stuti Mittal, Haresh Raulgaonkar. Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects. Int J Bus Econ Res. 2019;8(3):97-107. doi: 10.11648/j.ijber.20190803.13

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@article{10.11648/j.ijber.20190803.13,
  author = {Stuti Mittal and Haresh Raulgaonkar},
  title = {Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects},
  journal = {International Journal of Business and Economics Research},
  volume = {8},
  number = {3},
  pages = {97-107},
  doi = {10.11648/j.ijber.20190803.13},
  url = {https://doi.org/10.11648/j.ijber.20190803.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijber.20190803.13},
  abstract = {Objective: To study the biases in the prescription of Selective Serotonin Reuptake Inhibitors and the variation between the literature and the perception of doctors prescribing SSRIs. Methodology: The five drugs under study were sertraline, fluoxetine, fluvoxamine, paroxetine, escitalopram. The factors influencing the psychiatrist’s perceptions/ practice considered in this study are: A) Pharmacokinetic factors of the drug (Contra indications, Drug efficacy, Onset of action, Duration of action and the Bioavailability) B) Uses of the drug (for Social Anxiety Disorder, Generalized Anxiety Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder and Post-Traumatic Stress Disorder) C) Side effects (Somnolence, Anxiety, Tremors, Anorexia and sexual dysfunction) D) Patient’s Demographics (Gender, Age group, Special Groups- Geriatrics and Adolescents) E) Commercial aspects (Retail Price, Availability, Brand Value of the Parent Brand and Interpersonal Skills of the Medical Representative). Discussion: Contra-Indications: Theoretically, all SSRIs have the same number of contra-indications, since they have the same mechanism of action, though fluoxetine and paroxetine have a relatively higher potential of drug-drug interactions. Nonetheless, escitalopram was perceived to have the lowest, while fluvoxamine was perceived to have the highest number of contra-indications. Duration of action: There is no set difference between the duration of action of the 5 drugs under study, although, according to secondary research, 1/3rd of the total therapeutic effect at six weeks was apparent by the 1st week of treatment. Also, fluoxetine has the highest half-life at 2-4 days, while that of paroxetine is the least, at 16 hours. Yet, based on the study, Sertraline was perceived to have the highest duration of action. Demographics: Although there was no literature found to back this bias, Sertraline was the most preferred drug for us in geriatric patients, while Paroxetine was the least preferred. For adolescent populations, Paroxetine was the most preferred and Fluoxetine was the least preferred. Conclusion: There exists a gap between the theoretical evidence and the practical observations about the pharmacokinetics, uses and side effects of the 5 SSRIs under study. For example, sertraline, a drug proven to be useful in the treatment of depression, has an incorrect bias of causing anxiety as a side effect. This results in psychiatrists not prescribing an effective drug due to a bias with no theoretical basis, thus resulting in poorer treatment outcomes for the patient. For healthcare organizations, it means that they are losing out on almost half the potential patient population. Therefore, it would be useful for them to undertake communication campaigns that revolved around thwarting such biases, thus resulting in better treatment choices for patients and improved health outcomes.},
 year = {2019}
}

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TY  - JOUR
T1  - Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects
AU  - Stuti Mittal
AU  - Haresh Raulgaonkar
Y1  - 2019/06/12
PY  - 2019
N1  - https://doi.org/10.11648/j.ijber.20190803.13
DO  - 10.11648/j.ijber.20190803.13
T2  - International Journal of Business and Economics Research
JF  - International Journal of Business and Economics Research
JO  - International Journal of Business and Economics Research
SP  - 97
EP  - 107
PB  - Science Publishing Group
SN  - 2328-756X
UR  - https://doi.org/10.11648/j.ijber.20190803.13
AB  - Objective: To study the biases in the prescription of Selective Serotonin Reuptake Inhibitors and the variation between the literature and the perception of doctors prescribing SSRIs. Methodology: The five drugs under study were sertraline, fluoxetine, fluvoxamine, paroxetine, escitalopram. The factors influencing the psychiatrist’s perceptions/ practice considered in this study are: A) Pharmacokinetic factors of the drug (Contra indications, Drug efficacy, Onset of action, Duration of action and the Bioavailability) B) Uses of the drug (for Social Anxiety Disorder, Generalized Anxiety Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder and Post-Traumatic Stress Disorder) C) Side effects (Somnolence, Anxiety, Tremors, Anorexia and sexual dysfunction) D) Patient’s Demographics (Gender, Age group, Special Groups- Geriatrics and Adolescents) E) Commercial aspects (Retail Price, Availability, Brand Value of the Parent Brand and Interpersonal Skills of the Medical Representative). Discussion: Contra-Indications: Theoretically, all SSRIs have the same number of contra-indications, since they have the same mechanism of action, though fluoxetine and paroxetine have a relatively higher potential of drug-drug interactions. Nonetheless, escitalopram was perceived to have the lowest, while fluvoxamine was perceived to have the highest number of contra-indications. Duration of action: There is no set difference between the duration of action of the 5 drugs under study, although, according to secondary research, 1/3rd of the total therapeutic effect at six weeks was apparent by the 1st week of treatment. Also, fluoxetine has the highest half-life at 2-4 days, while that of paroxetine is the least, at 16 hours. Yet, based on the study, Sertraline was perceived to have the highest duration of action. Demographics: Although there was no literature found to back this bias, Sertraline was the most preferred drug for us in geriatric patients, while Paroxetine was the least preferred. For adolescent populations, Paroxetine was the most preferred and Fluoxetine was the least preferred. Conclusion: There exists a gap between the theoretical evidence and the practical observations about the pharmacokinetics, uses and side effects of the 5 SSRIs under study. For example, sertraline, a drug proven to be useful in the treatment of depression, has an incorrect bias of causing anxiety as a side effect. This results in psychiatrists not prescribing an effective drug due to a bias with no theoretical basis, thus resulting in poorer treatment outcomes for the patient. For healthcare organizations, it means that they are losing out on almost half the potential patient population. Therefore, it would be useful for them to undertake communication campaigns that revolved around thwarting such biases, thus resulting in better treatment choices for patients and improved health outcomes.
VL  - 8
IS  - 3
ER  -

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Author Information

Stuti Mittal

School of Pharmacy and Technology Management, Narsee Monjee Institute of Management Studies, Mumbai, India
Haresh Raulgaonkar

School of Pharmacy and Technology Management, Narsee Monjee Institute of Management Studies, Mumbai, India

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APA Style

Stuti Mittal, Haresh Raulgaonkar. (2019). Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects. International Journal of Business and Economics Research, 8(3), 97-107. https://doi.org/10.11648/j.ijber.20190803.13

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ACS Style

Stuti Mittal; Haresh Raulgaonkar. Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects. Int. J. Bus. Econ. Res. 2019, 8(3), 97-107. doi: 10.11648/j.ijber.20190803.13

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AMA Style

Stuti Mittal, Haresh Raulgaonkar. Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects. Int J Bus Econ Res. 2019;8(3):97-107. doi: 10.11648/j.ijber.20190803.13

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@article{10.11648/j.ijber.20190803.13,
  author = {Stuti Mittal and Haresh Raulgaonkar},
  title = {Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects},
  journal = {International Journal of Business and Economics Research},
  volume = {8},
  number = {3},
  pages = {97-107},
  doi = {10.11648/j.ijber.20190803.13},
  url = {https://doi.org/10.11648/j.ijber.20190803.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijber.20190803.13},
  abstract = {Objective: To study the biases in the prescription of Selective Serotonin Reuptake Inhibitors and the variation between the literature and the perception of doctors prescribing SSRIs. Methodology: The five drugs under study were sertraline, fluoxetine, fluvoxamine, paroxetine, escitalopram. The factors influencing the psychiatrist’s perceptions/ practice considered in this study are: A) Pharmacokinetic factors of the drug (Contra indications, Drug efficacy, Onset of action, Duration of action and the Bioavailability) B) Uses of the drug (for Social Anxiety Disorder, Generalized Anxiety Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder and Post-Traumatic Stress Disorder) C) Side effects (Somnolence, Anxiety, Tremors, Anorexia and sexual dysfunction) D) Patient’s Demographics (Gender, Age group, Special Groups- Geriatrics and Adolescents) E) Commercial aspects (Retail Price, Availability, Brand Value of the Parent Brand and Interpersonal Skills of the Medical Representative). Discussion: Contra-Indications: Theoretically, all SSRIs have the same number of contra-indications, since they have the same mechanism of action, though fluoxetine and paroxetine have a relatively higher potential of drug-drug interactions. Nonetheless, escitalopram was perceived to have the lowest, while fluvoxamine was perceived to have the highest number of contra-indications. Duration of action: There is no set difference between the duration of action of the 5 drugs under study, although, according to secondary research, 1/3rd of the total therapeutic effect at six weeks was apparent by the 1st week of treatment. Also, fluoxetine has the highest half-life at 2-4 days, while that of paroxetine is the least, at 16 hours. Yet, based on the study, Sertraline was perceived to have the highest duration of action. Demographics: Although there was no literature found to back this bias, Sertraline was the most preferred drug for us in geriatric patients, while Paroxetine was the least preferred. For adolescent populations, Paroxetine was the most preferred and Fluoxetine was the least preferred. Conclusion: There exists a gap between the theoretical evidence and the practical observations about the pharmacokinetics, uses and side effects of the 5 SSRIs under study. For example, sertraline, a drug proven to be useful in the treatment of depression, has an incorrect bias of causing anxiety as a side effect. This results in psychiatrists not prescribing an effective drug due to a bias with no theoretical basis, thus resulting in poorer treatment outcomes for the patient. For healthcare organizations, it means that they are losing out on almost half the potential patient population. Therefore, it would be useful for them to undertake communication campaigns that revolved around thwarting such biases, thus resulting in better treatment choices for patients and improved health outcomes.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Study of Biases in the Prescription of SSRIs with Respect to Pharmacokinetic, Applicative, Demographic, and Commercial Aspects
AU  - Stuti Mittal
AU  - Haresh Raulgaonkar
Y1  - 2019/06/12
PY  - 2019
N1  - https://doi.org/10.11648/j.ijber.20190803.13
DO  - 10.11648/j.ijber.20190803.13
T2  - International Journal of Business and Economics Research
JF  - International Journal of Business and Economics Research
JO  - International Journal of Business and Economics Research
SP  - 97
EP  - 107
PB  - Science Publishing Group
SN  - 2328-756X
UR  - https://doi.org/10.11648/j.ijber.20190803.13
AB  - Objective: To study the biases in the prescription of Selective Serotonin Reuptake Inhibitors and the variation between the literature and the perception of doctors prescribing SSRIs. Methodology: The five drugs under study were sertraline, fluoxetine, fluvoxamine, paroxetine, escitalopram. The factors influencing the psychiatrist’s perceptions/ practice considered in this study are: A) Pharmacokinetic factors of the drug (Contra indications, Drug efficacy, Onset of action, Duration of action and the Bioavailability) B) Uses of the drug (for Social Anxiety Disorder, Generalized Anxiety Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder and Post-Traumatic Stress Disorder) C) Side effects (Somnolence, Anxiety, Tremors, Anorexia and sexual dysfunction) D) Patient’s Demographics (Gender, Age group, Special Groups- Geriatrics and Adolescents) E) Commercial aspects (Retail Price, Availability, Brand Value of the Parent Brand and Interpersonal Skills of the Medical Representative). Discussion: Contra-Indications: Theoretically, all SSRIs have the same number of contra-indications, since they have the same mechanism of action, though fluoxetine and paroxetine have a relatively higher potential of drug-drug interactions. Nonetheless, escitalopram was perceived to have the lowest, while fluvoxamine was perceived to have the highest number of contra-indications. Duration of action: There is no set difference between the duration of action of the 5 drugs under study, although, according to secondary research, 1/3rd of the total therapeutic effect at six weeks was apparent by the 1st week of treatment. Also, fluoxetine has the highest half-life at 2-4 days, while that of paroxetine is the least, at 16 hours. Yet, based on the study, Sertraline was perceived to have the highest duration of action. Demographics: Although there was no literature found to back this bias, Sertraline was the most preferred drug for us in geriatric patients, while Paroxetine was the least preferred. For adolescent populations, Paroxetine was the most preferred and Fluoxetine was the least preferred. Conclusion: There exists a gap between the theoretical evidence and the practical observations about the pharmacokinetics, uses and side effects of the 5 SSRIs under study. For example, sertraline, a drug proven to be useful in the treatment of depression, has an incorrect bias of causing anxiety as a side effect. This results in psychiatrists not prescribing an effective drug due to a bias with no theoretical basis, thus resulting in poorer treatment outcomes for the patient. For healthcare organizations, it means that they are losing out on almost half the potential patient population. Therefore, it would be useful for them to undertake communication campaigns that revolved around thwarting such biases, thus resulting in better treatment choices for patients and improved health outcomes.
VL  - 8
IS  - 3
ER  -

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