Dilemma of prescribing aripiprazole under the Taiwan health insurance program: a descriptive study.

OBJECTIVES: Refractory major depressive disorder (MDD) is a serious problem leading to a heavy economic burden. Antipsychotic augmentation treatment with aripiprazole and quetiapine is approved for MDD patients and can achieve a high remission rate. This study aimed to examine how psychiatrists in Taiwan choose medications and how that choice is influenced by health insurance payments and administrative policy. DESIGN: Descriptive study. OUTCOME MEASURES: Eight questions about the choice of treatment strategy and atypical antipsychotics, and the reason to choose aripiprazole. INTERVENTION: We designed an augmentation strategy questionnaire for psychiatrists whose patients had a poor response to antidepressants, and handed it out during the annual meeting of the Taiwanese Society of Psychiatry in October 2012. It included eight questions addressing the choice of treatment strategy and atypical antipsychotics, and the reason whether or not to choose aripiprazole as the augmentation antipsychotic. RESULTS: Choosing antipsychotic augmentation therapy or switching to other antidepressant strategies for MDD patients with an inadequate response to antidepressants was common with a similar probability (76.1% vs 76.4%). The most frequently used antipsychotics were aripiprazole and quetiapine, however a substantial number of psychiatrists chose olanzapine, risperidone, and sulpiride. The major reason for not choosing aripiprazole was cost (52.1%), followed by insurance official policy audit and deletion in the claims review system (30.1%). CONCLUSION: The prescribing behavior of Taiwanese psychiatrists for augmentation antipsy-chotics is affected by health insurance policy.

Can topical duloxetine be used for neuropathic pain?

Duloxetine is a serotonin and norepinephrine re-uptake inhibitor with both anti-depressant and pain-relieving properties. Its pain-relieving properties are due to its action on the descending inhibitory pain pathways. However, the fast onset of analgesia may be mediated by mechanisms other than the descending inhibitory pain pathways. This study posits the hypothesis that duloxetine may have pain-relieving property by peripheral analgesic effects. Ways of testing this hypothesis and its potential topical use are discussed.