Evaluation of Prescribing Patterns Medication Adherence and Quality Of Life in Patients with Depression at Psychiatric Department

Mariyabi SK; Likhita Gayatri P; Suhana Parveen P; Nandhini G; Venkata Nagaraju G

doi:10.37022/wjcmpr.v8i2.424

Authors

SK. Mariyabi Department of Pharmacy Practice, Hindu College of Pharmacy, Amaravathi Road Guntur, Andhra Pradesh, India.
P. Likhita Gayatri Department of Pharmacy Practice, Hindu College of Pharmacy, Guntur, A.P, India.
P. Suhana Parveen Department of Pharmacy Practice, Hindu College of Pharmacy, Guntur, A.P, India.
G. Nandhini Department of Pharmacy Practice, Hindu College of Pharmacy, Guntur, A.P, India.
G. Venkata Nagaraju Department of Pharmacy Practice, Hindu College of Pharmacy, Guntur, A.P, India.

Abstract

A prospective observational case-control study was conducted to assess prescribing practices, medication adherence, quality of life, and the impact of clinical pharmacist interventions on medication adherence, medication errors, patient education, and therapeutic outcomes among patients suffering from depression at the Department of Psychiatry, Government General Hospital, Guntur. A total of 81 patients with depression, aged between 15 and 65 years, were enrolled in the study. Data regarding socio-demographic characteristics, disease-related information, prescribing patterns, medication adherence, and quality of life were collected during the study period from October 2024 to March 2025. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS) questionnaire, while quality of life was evaluated using the WHOQOL-BREF questionnaire. The study findings revealed variations in prescribing patterns, with a notable prevalence of polypharmacy. Following clinical pharmacist interventions, including patient counselling and medication review, an improvement in medication adherence was observed among patients in the intervention group. Furthermore, patients who received pharmacist-led interventions demonstrated better quality of life, particularly in the physical and psychological domains. The interventions also contributed to a reduction in medication-related adverse effects and improved patient satisfaction. In conclusion, clinical pharmacist interventions can play an important role in optimizing prescribing practices, improving medication adherence, reducing medication-related problems, and enhancing the quality of life and therapeutic outcomes of patients with depression.

Keywords:

Depression, Prescribing Patterns, medication adherence, quality of life, clinical pharmacist intervention, polypharmacy, WHO QOL-BREF, MARS

DOI

https://doi.org/10.37022/wjcmpr.v8i2.424

References

1. Ara SK. Analysis of the prescribing pattern of antidepressants and the side effects in depression patients. Journal of family medicine and primary care. 2022 Nov 1;11(11):6640-5.

2. https://www.nimh.nih.gov/health/publications/depression#:~:text=What%20is%20depression?,to%20depression%20symptoms%20as%20well

3. Sandeep Grover SG, Alakananda Dutt AD, Ajit Avasthi AA. An overview of Indian research in depression.

4. Dadi AF, Miller ER, Bisetegn TA, Mwanri L. Global burden of antenatal depression and its association with adverse birth outcomes: an umbrella review. BMC public health. 2020 Dec; 20:1-6

5. Zhu S, Zhao L, Fan Y, Lv Q, Wu K, Lang X, Li Z, Yi Z, Geng D. Interaction between TNF-α and oxidative stress status in first-episode drug-naïve schizophrenia. Psychoneuroendocrinology. 2020 Apr 1;114:104595.

6. Park LT, Zarate Jr CA. Depression in the primary care setting. New England Journal of Medicine. 2019 Feb 7;380(6):559-68.

7. Al-Harbi KS. Treatment-resistant depression: therapeutic trends, challenges, and future directions. Patient preference and adherence. 2012 May 1:369-88.

8. Costello CG, Scott CB. Primary and secondary depression: a review. The Canadian Journal of Psychiatry. 1991 Apr;36(3):210-7.

9. Clayton PJ, Lewis CE. The significance of secondary depression. Journal of affective disorders. 1981 Mar 1;3(1):25-35.

10. Fallahnia N, Ansari L, Mohammadkhani H, Mousazadeh F, Mohammadi Khah M, Ketabchi G. Oral cancer: Nanoparticles as a new horizon in the diagnosis and phototherapy-based therapies. Nanomedicine Research Journal. 2022 Apr 1;7(2):124-39.

11. Field T. Postpartum depression effects, risk factors and interventions: a review. Clin Depress. 2017;3(122):1-3.

12. Fisch RZ. Masked depression: its interrelations with somatization, hypochondriasis and conversion. The International Journal of Psychiatry in Medicine. 1988 Dec;17(4):367-79.

13. Sullivan PF, Neale MC, Kendler KS. Genetic epidemiology of major depression: review and meta-analysis. American journal of psychiatry. 2000 Oct 1;157(10):1552-62.

14. Duman RS, Aghajanian GK, Sanacora G, Krystal JH. Synaptic plasticity and depression: new insights from stress and rapid-acting antidepressants. Nature medicine. 2016 Mar;22(3):238-49.

15. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine. 1998 May 1;14(4):245-58.

16. Beck AT. Depression: Clinical, experimental, and theoretical aspects. Harper & Row google schola. 1967;2:103-13.

17. Forbes MP, O’Neil A, Lane M, Agustini B, Myles N, Berk M. Major depressive disorder in older patients as an inflammatory disorder: implications for the pharmacological management of geriatric depression. Drugs & Aging. 2021 Jun;38:451-67.

18. Institute of Health Metrics and Evaluation MH. Global health data exchange (GHDx).

19. Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of affective disorders. 2017 Sep 1;219:86-92.

20. Beirão D, Monte H, Amaral M, Longras A, Matos C, Villas-Boas F. Depression in adolescence: a review. Middle East current psychiatry. 2020 Oct 2;27(1):50.

21. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

22. https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013

23. Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian & New Zealand Journal of Psychiatry. 2015 Dec;49(12):1087-206.

24. World Health Organization. Depression: A global public health concern [Internet]. 2012

25. Sansone RA, Sansone LA. Antidepressant adherence: are patients taking their medications?. Innovations in clinical neuroscience. 2012 May;9(5-6):41.

26. Nel A, Kagee A. Common mental health problems and antiretroviral therapy adherence. AIDS care. 2011 Nov 1;23(11):1360-5.

27. Sabaté E, editor. Adherence to long-term therapies: evidence for action. World Health Organization; 2003.

28. American Psychiatric Association. The American Psychiatric Association practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Pub; 2024 Nov 22

29. Cosgrove L, Brhlikova P, Lyus R, Herrawi F, D’Ambrozio G, Abi-Jaoude E, Pollock AM. Global Burden Disease Estimates for Major Depressive Disorders (MDD): A review of diagnostic instruments used in studies of prevalence. Community mental health journal. 2024 Nov;60(8):1493-503.

30. Madsen TE, Bourjeily G, Hasnain M, Jenkins M, Morrison MF, Sandberg K, et al. Sex and gender differences research design for basic, clinical, and population studies: Essentials for investigators. J Womens Health (Larchmt). 2020;29(9):1133–40.

31. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099–104.

32. Smith JP. The impact of socioeconomic status on health over the life-course. J Hum Resour. 2007;42(4):739–64.

33. World Health Organization. How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators. Geneva: WHO; 1993.

34. Desalegn AA. Assessment of drug use pattern using WHO prescribing indicators at Hawassa University teaching and referral hospital, south Ethiopia: a cross-sectional study. BMC Health Serv Res. 2013;13:170.

35. Sirohi P, Pandey A, Dixit AK. Evaluation of drug prescribing pattern in rural health teaching hospital using WHO prescribing indicators. Int J Basic Clin Pharmacol. 2016;5(3):651–4.

36. Agarwal M, Kumar S, Singh S. Gender differences in health behavior and adherence to medical treatments: A review. J Health Psychol. 2021;26(4):514-530. doi: 10.1177/1359105319841225.

37. Jones RT, Taylor LB. Prevention and management of severe disease in clinical populations: Insights from intervention research. Lancet. 2020;395(10236):1087-1098. doi: 10.1016/S0140-6736(19)32950-2.

38. White RA, Brown PG, Stevenson JT. Early intervention and the prevention of severe disease progression: A review of clinical outcomes. J Prev Med. 2019;56(4):325-332. doi: 10.1016/j.ypmed.2018.12.019.

39. factors. J Phys Health. 2019;45(2):217-226. doi: 10.1016/j.jphy.2019.01.013.

40. Johnson AR, Patel PK. Factors influencing physical health: A comprehensive review of social determinants.Soc Sci Med. 2018;197:99-107. doi: 10.1016/j.socscimed.2017.11.026.

41. Williams L, Han J, Hwang J. Psychological health and its implications for public health: A global review. J Psychol Health. 2020;34(3):420-430. doi: 10.1080/08870446.2020.1749432