Prospective pharmaceutical counseling in the treatment of patients with anxiety and depressive disorders

The increasing prevalence of anxiety–depressive disorders has led to a growing use of antidepressants, and is accompanied by an elevated risk of polypharmacy and drug-related problems, especially in patients with chronic somatic diseases. In this context, prospective pharmaceutical counseling is a critical tool to improve the safety of pharmacotherapy, prevent potential drug–drug interactions, and enable individualized treatment. Aim. To develop an algorithm for minimizing the risk of drug-related problems when prescribing antidepressants to patients with anxiety–depressive disorders by introducing prospective pharmaceutical counseling. Materials and methods. As part of the study, a questionnaire was developed to identify potential drug-related problems when prescribing antidepressants to patients with anxiety–depressive disorders. The questionnaire, which was filled out by psychiatrists during outpatient consultations, included data on comorbidities, concomitant medications, dietary supplements, and lifestyle factors. Based on the completed questionnaires, and without access to patients’ personal data, the pharmacist performed a real-time risk assessment of drug-related problems and provided recommendations for optimizing the pharmacotherapy. Results and discussion. The analysis of the survey revealed a high prevalence of comorbid conditions and polypharmacy among patients receiving antidepressants: 76 % had comorbidities, and 24 % were prescribed five or more medications concurrently. The most frequent drug-related problems were potential pharmacokinetic interactions, accounting for 71.1 % of all identified cases. A statistically significant correlation was found between the patient age, the number of prescribed drugs, and the number of drug-related problems identified. An algorithm for assessing and minimizing the risk of drug-related problems was developed and proposed. Conclusions. Prospective pharmaceutical counseling based on the questionnaire data has enabled the structured identification of potential drug-related problems and the development of clinically oriented practical recommendations. The results obtained confirm the feasibility of integrating pharmacists into a multidisciplinary team when prescribing antidepressants.