Table 4.

Summary of final indicators of overprescribing with median ratings of 7 to 9 on the necessity to review without disagreement

Overprescribing indicators	Median	Agreement	Range
Depression
1. Prescribed an antidepressant - and the patient has a first episode of mild depression	8	70%	3–9
2. Co-prescribed two antidepressants - and the patient has a first episode of moderate depression	8	67%	3–9
3. Prescribed an antidepressant in monotherapy for ≥ 4 weeks - and the patient is aged < 65 years with no signs of clinically relevant symptom improvement1	7	80%	4–9
4. Prescribed an antidepressant in monotherapy for ≥ 6 weeks - and the patient is aged ≥ 65 years with no signs of clinically relevant symptom improvement1	9	90%	6–9
5. Prescribed an antidepressant in monotherapy - and the patient has previously used two or more different antidepressants (inadequate response)	7	70%	3–9
6. Prescribed an antidepressant in monotherapy, combination, or augmentation > 12 months for a first episode of moderate or severe depression - and the patient has achieved full remission	7	80%	3–9
7. Prescribed an antidepressant in monotherapy, combination, or augmentation > 2 years with a history of 2 or more depressive episodes with functional impairment in the last 5 years - and the patient has achieved full remission	7	70%	4–9
8. Prescribed SSRI at a dose of > 1 DDD - and the patient has no clinically relevant symptom improvement under an SSRI dose ≤ 1 DDD (no further dose increase if symptoms remain/worsen)	8	70%	3–9
9. Prescribed two antidepressants - and none of those is mirtazapine, mianserin, or trazodone	8	90%	6–9
Anxiety
1. Prescribed an antidepressant for ≥ 8 weeks - and the patient is aged < 65 years with no signs of clinically relevant symptom improvement1	8	90%	6–9
2. Prescribed an antidepressant for ≥ 12 weeks - and the patient is aged ≥ 65 years with no signs of clinically relevant symptom improvement	8	100%	7–9
3. Prescribed an antidepressant > 12 months for anxiety - and the patient has achieved full remission	7	70%	2–9
4. Prescribed an antidepressant for anxiety - and the patient is co-prescribed benzodiazepine > 4 weeks	9	100%	7–9
Insomnia
1. Prescribed TCA ≥ 50 mg/day for insomnia2 - and the patient has no other indications for an antidepressant	7	70%	5–9
2. Prescribed trazodone ≥ 50 mg/day for insomnia - and the patient has no other indications for an antidepressant	8	80%	5–9
3. Prescribed mirtazapine ≥ 30 mg/day for insomnia - and the patient has no other indications for an antidepressant	7	80%	3–9
4. Prescribed a sedating antidepressant > 8 weeks for insomnia  - and the patient has no other indications for an antidepressant	8	80%	5–9
Pain
1. Prescribed a TCA ≥ 75 mg/day for neuropathic pain  - and the patient has no other indications for an antidepressant	7	60%	3–9
2. Prescribed venlafaxine ≥ 150 mg/day for neuropathic pain  - and the patient has no other indications for an antidepressant	8	80%	6–9
3. Prescribed SSRI or mirtazapine for neuropathic pain  - and the patient has no other indications for an antidepressant	8	90%	6–9
4. Prescribed any antidepressant for non-specific low back pain  - and the patient has no other indications for an antidepressant	8	90%	6–9
5. Prescribed TCA or SNRI as analgesic for pain (e.g., pain other than neuropathic pain, tension headache, migraine, or fibromyalgia syndrome)  - and the patient has no other indications for an antidepressant	8	70%	5–9
Miscellaneous
1. Prescribed any antidepressant  - and the patient has chronic heart failure and a first episode of mild or moderate depression	7	70%	2–9
2. Prescribed any antidepressant  - and the patient has dementia and a first episode of mild or moderate depression	7	70%	2–9
3. Prescribed agomelatine  - and the patient is aged ≥ 75 years	7	70%	5–9

DDD defined daily dose, SSRI selective serotonin reuptake inhibitors, SNRI selective serotonin-norepinephrine reuptake inhibitors, TCA tricyclic antidepressant

¹At the maximum tolerated or recommended dose

²Irrespective of the length of the treatment