The use of selective serotonin reuptake inhibitors among Swedish psychiatrists - Results of a questionnaire

A questionnaire concerning the use of selective serotonin reuptake inhibitors (SSRIs), in part as a follow-up to a previous inquiry, was distributed to the members of the Swedish Psychiatric Association. The inquiry was distributed in June 1995 and consisted of 21 questions. Of the 1357 distributed questionnaires, 648 were returned (48%). SSRIs are reported to be, without any comparison, the commonest alternative in treatment of major depression, which is in contrast to the result of the previous questionnaire distibuted in 1993, when tricyclic antidepressants (TCAs) still were the main alternative. Most of the replying psychiatrists (65%) considered the antidepressant effect of the SSRIs, in general, to be comparable with that of the TCAs, but only 20% considered SSRIs to be comparable in treatment of severe depressions (melancholia). The use of SSRIs for several other indications besides major depression seems to be rather common, even though SSRIs are not approved for most of these indications. The most commonly used alternative for a depressed patient not responding to an SSRI is a change to a TCA, but more than 50% of the psychiatrists reported that they are using augmentation therapy as another alternative. In most cases either mianserin or buspirone is added, despite scant literature evidence supporting an addition of these compounds. Many unusual side effects were reported, most of them already known from case reports in the literature. Some of the mentioned side effects, such as irritability, agitation, restlessness, confusion, tremor, and myoclonia could have been indicative of unrecognized mild serotonergic syndromes. Withdrawal symptoms were reported. Sexual dysfunctions caused by SSRIs are observed in about 38% of the treated patients. Developing knowledge about the pharmacokinetics of the SSRIs seems to be of importance for many psychiatrists in the selection of a specific SSRI.