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Psychiatric emergency (PE) as related to major depressive disorder (MDD) is most commonly understood as the presentation of suicidality or a risk of violence to others. However, MDD-PE can have a wide variety of clinical presentations. The challenges in treating PE arise from the difficulty in fully defining and diagnosing this condition, especially by emergency department and non-psychiatric medical personnel. Additionally, determining the appropriate level of care, as well as resource and other constraints, further complicates the management of MDD-PE. This manuscript reviews the definition, diagnosis, and management of MDD-PE globally, and provides recommendations for clinicians in the context of Hong Kong clinical practice. It reflects the outcomes of a meeting of psychiatrists in Hong Kong convened by the Asian Association of Neuropsychopharmacology. The primary goal of the diagnostic process is to determine a patient's level of risk to themselves and others. The main recommendations include educating clinicians on the diverse presentation of MDD-PE and non-clinical factors that may contribute to risk assessment-emphasizing contextual factors during history-taking. The recommendations also include the stratification of patients into three categories depending on (1) whether hospitalization is warranted and (2) the urgency and intensity of required intervention, with the aim of optimizing resources. Finally, the role of novel interventions, such as fast-acting or non-invasive ones, is discussed.
Electroconvulsive therapy (ECT) is an effective and safe medical treatment for patients with severe mood and neuropsychiatric disorders. Since the advent of ECT, extensive research has been performed to identify the predictive factors for response to ECT. In recent decades, postictal suppression on an electroencephalogram (EEG) has been considered a potential predictor of response to ECT. We aimed to investigate the direct association between postictal suppression and the therapeutic effects of ECT. In this systematic review, all articles in the field of the association between postictal suppression and the therapeutic effects of ECT published between 1990 and 2021 were identified. The full texts of these articles, which include clinical trials and retrospective and cross-sectional studies, are available in scholarly research databases and search engines, including PubMed, Google Scholar, OVID, Web of Science, and Scopus. Of all retrieved articles, eight studies, including four retrospective cohort articles and four clinical trials, met the inclusion criteria for further analyses. The findings of this study showed a significant association between postictal suppression and the therapeutic efficacy of ECT. Factors such as electrode placement, tachycardia, type of anesthetic agent, and EEG amplitude were also directly related to postictal suppression and the efficacy of ECT. Postictal suppression on EEG can be considered a predictor of response to ECT. To increase the effectiveness of treatment with ECT and increase postictal suppression, factors including electrode placement, tachycardia, type of anesthesia, and EEG amplitude should be considered, which highlights the need for further research.
Depressive symptoms and sleep problems are prevalent among older adults with depression. To reduce their adverse impact, it is important to understand the changes in symptom patterns as the Coronavirus disease 2019 (COVID-19) pandemic emerged. This longitudinal study examined the interactive changes between depressive symptoms and sleep problems among older adults with depression before and during the COVID-19 pandemic from a network perspective in the USA. This network analysis study was based on data from the three waves (2016, 2018, and 2020) of the Health and Retirement Study (HRS). Depressive symptoms were measured using the eight-item version of the Center for Epidemiologic Studies Depression Scale (CESD-8), and sleep problems were assessed with the four-item Jenkins Sleep Scale (JSS-4). The study examined central symptoms and bridge symptoms within the network model. A total of 2905 older adults with depression were included in the analyses. The prevalence of depressive symptoms did not significantly change in the study wave during the COVID-19 compared to the pre-pandemic waves. "Feeling Depressed" was the most central symptom of the depression-sleep problems network in the 2016 wave, while "Feeling Sad" was the most central symptom in both the 2018 and 2020 waves. Additionally, "Feeling Loneliness" was the key bridge symptom of the depression-sleep problems network in the 2016 wave, while "Not Enjoying Life" was the key bridge symptom in the 2018 wave, and "Feeling Rested in Morning" was the key bridge symptom in the 2020 wave. The findings highlighted that central and bridge symptoms were potential targets in treating depressive symptoms and sleep problems among older adults with depression across the study period in the USA.
Hikikomori, particularly among young adults, has gained growing attention. This study explored the nonlinear associations of loneliness and insomnia with subclinical hikikomori among college students. A total of 6514 college students were assessed in this study. The University of California Los Angeles Loneliness Scale (UCLA-LS), the seven-item Insomnia Severity Index questionnaire (ISI-7), and the 1-month version of the HQ-25 (HQ-25M) were used to measure loneliness, insomnia, and subclinical hikikomori, respectively. Restricted cubic spline (RCS) models were utilized to characterize the nonlinear relationships between different measures. After adjusting for confounders, the RCS models revealed that loneliness and insomnia had significant nonlinear relationships with hikikomori, with both showing a dose-response pattern. A J-shaped relationship was observed between loneliness and subclinical hikikomori, with an inflection point at UCLA-LS = 50.15. Additionally, a significant nonlinear relationship between insomnia and subclinical hikikomori was also found, with an inflection point at ISI-7 = 4.08. Scores above these thresholds for UCLA-LS and ISI-7 were associated with increased risk of hikikomori. Subgroup analyzes did not reveal any significant moderating effects. Regarding the associations of loneliness and insomnia with the risk of subclinical hikikomori, the inflection points for participants with a history of psychiatric problems and perceived poor health status were lower than those in the other groups. Given the adverse impacts of hikikomori on college students, it is important to develop appropriate preventive and treatment strategies to address loneliness and insomnia in this vulnerable population.
To determine the effect of hope on functional recovery in individuals diagnosed with schizophrenia. This correlational, cross-sectional study was conducted at the Psychiatry Outpatient Clinic of a hospital in eastern Türkiye between June 2022 and January 2023. Data were collected using a personal information form, the Herth Hope Index (HHI), and the Functional Remission of General Schizophrenia (FROGS) scale. The study included 136 patients diagnosed with schizophrenia according to the DSM-5 diagnostic criteria. Data were analyzed using percentage distributions and mean values, as well as Pearson correlation and regression analyses. The mean total FROGS score of the patients was found to be 47.25 ± 15.2, while the mean total HHS score was 45.22 ± 22.63. A statistically significant positive correlation was identified between the mean scores of all subscales of the FROGS and HHS, as well as between their total scores (p < 0.05). Regression analysis revealed that the level of hope in patients with schizophrenia had a 60% effect on functional recovery (F = 203.61; R2 = 0.603; p ≤ 0.001). The findings of this study indicated that patients diagnosed with schizophrenia had moderate levels of hope but low functional recovery scores. Additionally, a significant and positive relationship was observed between hope and functional recovery, demonstrating that hope is an influential factor in enhancing functional recovery. Therefore, it is recommended that interventions aimed at increasing levels of hope be planned and implemented within treatment and rehabilitation programs.
The COVID-19 pandemic has been associated with detrimental effects on mental health and psychological well-being. Although multiple studies have shown decreases in mental health-related Emergency Department (ED) presentations early in the COVID-19 pandemic, the medium-term effects on mental health-related ED presentations have remained less clear. This study aimed to evaluate the effect of the pandemic on mental health ED presentations by comparing observed presentation numbers to predictions from pre-pandemic data. This retrospective cohort study tallied weekly ED presentations associated with mental health disorders from a state-wide minimum dataset. Three time periods were identified: Pre-Pandemic (January 1, 2018-March 8, 2020), Statewide Lockdown (March 9, 2020-June 28, 2020), and Restrictions Easing (June 29, 2020-June 27, 2021). Time series analysis was used to generate weekly presentation forecasts using pre-pandemic data. Observed presentation numbers were compared to these forecasts. Weekly presentation numbers were lower than predicted in 11 out of 16 weeks in the Statewide Lockdown period and 52 out of 52 weeks in the Restrictions Easing period. The largest decrease was seen for anxiety disorders (Statewide Lockdown: 76.8% of forecast; Restrictions Easing: 36.4% of forecast), while an increase was seen in presentations for eating disorders (Statewide Lockdown: 139.5% of forecast; Restrictions Easing: 194.4% of forecast). Overall weekly mental health-related presentations across Queensland public EDs were lower than expected for the first 16 months of the COVID-19 pandemic. These findings underline the limitations of emergency department provision of mental health care and the importance of alternate care modalities in the pandemic context.
Rapid cycling (RC) is a special subtype of bipolar disorder (BD). Previous studies have rarely involved the investigation of neurological soft signs (NSS) and emotional intelligence (EI) in rapid cycling patients. This study aims to compare the differences in NSS and EI between patients with RC and non-rapid cycling (NRC) in BD. The Cambridge Neurological Inventory and The Mayer-Salovey-Caruso Emotional Intelligence Test were used to assess the NSS and EI levels of euthymic patients with BD and healthy controls (HC). Patients were divided into RC and NRC groups. In terms of NSS, both the RC and NRC groups scored significantly higher than the HC group in the Motor coordination subdomain and total scores. In the Sensory integration subdomain, there was a significant trend of RC group scoring higher than the NRC group, which in turn scored higher than the HC group. In terms of EI, there was a trend of RC group scoring lower than the NRC group, which scored lower than the HC group in the understanding emotions subdomain and MSCEIT total score. In the managing emotions subdomain, the RC group scored lower than the HC group. Compared to the NRC group, the RC group exhibited higher NSS levels, mainly manifesting in more severe sensory integration impairment. The RC group scored lower in EI, primarily reflected in understanding and managing emotions, and the managing emotions subdomain may serve as a more sensitive indicator to distinguish between the two groups.
While the importance of mental health and its impact on overall health and well-being has been widely recognized, there continue to be ongoing barriers to accessing mental health services. This is particularly poignant in countries in Southeast Asia (SEA) where there may be further stigma in accessing mental health services. As no reviews have been undertaken on this topic, this review aims to outline the barriers and enablers to access and utilization of mental health care services in SEA. Searches were undertaken in commercially produced and gray literature sources. Two independent reviewers screened the results. The data were then independently extracted, which was then collated and synthesized, using the Health Belief Model (HMB) as a framework. Twelve studies were included in the review. Under the HBM, barriers were grouped into: stigma, poor health literacy, internalized reasons, cultural beliefs, lack of training of health professionals, quality of service, and poor distribution of resources. Enablers included: social support, outreach services, structural stigma, self-awareness, resources and information, accessibility and affordability, and positive attitudes and beliefs about health professionals. Those accessing mental health care in SEA are confronted by complex barriers and few enablers. Ongoing stigma and a distinct lack of resources pose the greatest challenges, which are even more amplified for those in rural areas and minority groups. A multifaceted strategy that improves the structures, processes, and outcomes of mental health is required within these communities.
Postpartum depression (PPD) is a chronic mood illness that typically develops in the first few months after giving birth. It affects 17.2% of women worldwide, and its deleterious consequences on infants, children, and mothers have elicited global public concern. Therefore, this paper aims to present an overview of the relationship between emotional support and PPD among postpartum mothers in the Asia region. An extensive search using various keywords was conducted in Science Direct, PsycINFO, PubMed, Scopus, Cochrane Library, JSTOR, Springer Link, and Taylor Francis. The screening process was compliant with the PRISMA guideline, while the quality of the selected studies was assessed using the QuADS tool. The analysis included 15 research from 12 different countries with 6031 postpartum mothers. A decreased risk of PPD for postpartum mothers is shown to be significantly correlated with greater emotional support, and vice versa. Asian women are less likely to seek emotional assistance than other mothers, which is influenced by culture. There needs to be more research on the impact of culture on postpartum mothers' emotional support. Additionally, this review hopes to raise awareness among the mothers' friends and family as well as the medical community to be more attentive to postpartum mothers' emotional needs and offer specialized assistance.
To compare the effect of family integrated care (FICare) on maternal stress in preterm infants with traditional non-parent neonatal intensive care unit (NICU) care. We continuously enrolled mothers and their preterm infants from two NICUs between August 2014 and April 2017; while one NICU applied the FICare model (FICare group) and the other performed standard non-parent care model (control group). Maternal stress was evaluated by the Parental Stress Scale: NICU (PSS: NICU) on admission and right before the discharge. A generalized linear model to adjust for potential confounders. Subgroup analysis was also performed for comparisons between two groups. A total of 215 mothers with preterm infants were included in this study, among whom 118 (54.88%) were in FICare group and 97 (45.12%) were in control group. The mean PSS: NICU score was 117.36 ± 26.27 on admission with no difference between two groups. Before being discharged home, the PSS: NICU score of parents in both groups was significantly reduced, with the score of FICare group was significantly lower than that of control group. In all sub-domains of PSS: NICU score as sights and sounds, baby looks and behavior score, and parental role, the scores of FICare group were significantly lower than control group. There was a simultaneous decrease of maternal stress for NICU preterm infants. FICare further facilitates reducing the maternal stress. It shall be encouraged to apply FICare model in NICUs.
Major depressive disorder (MDD) is one of the global burdens of disease, and its pathogenesis remains unclear. An increasing amount of research indicates that ghrelin regulates mood in patients with MDD. Still, current results are inconsistent, and the mechanisms underlying how ghrelin modulates depressive symptoms are inconclusive, especially in first-episode drug-naïve MDD patients. Therefore, this study aims to investigate the relationship and potential mechanism between ghrelin and first-episode drug-naïve MDD. Ninety first-episode drug-naïve MDD patients and 65 healthy controls (HCs) were included. Hamilton Depression Scale (HAMD-17) as a measure of depressive symptoms. Plasma levels of ghrelin and hypothalamic-pituitary-adrenal axis (HPA-axis) hormones were measured in all participants. Compared to HCs, the ghrelin levels were higher in the MDD (p < .001) and still showed significance after covarying for sex, age, and Body Mass Index (BMI). Ghrelin was positively related to corticotropin-releasing-hormone (CRH) levels (r = .867, p < .001), adrenocorticotropic hormone (ACTH) levels (r = .830, p < .001), and cortisol levels (r = .902, p < .001) in partial correlation analysis. In addition, there was a positive correlation between HAMD total score and ghrelin levels (r = .240, p = .026). Other than that, the HAMD total score also had a positive correlation with the CRH (r = .333, p = .002) and cortisol (r = .307, p = .004) levels. Further mediation analysis demonstrated that the relationship between ghrelin and HAMD total score was mediated by CRH (ab-path; β = .4457, 95% CI = 0.0780-1.0253, c-path; β = .2447, p = .0260, c'-path; β = -.2009, p = .3427). These findings revealed that plasma ghrelin provides a pivotal link to depressive symptoms in first-episode drug-naive MDD patients. CRH mediated the relationship between ghrelin and HAMD total score. It might provide new insights into understanding the pathogenesis of MDD, contributing to intervention and treatment from this approach.
Antipsychotic polypharmacy (APP) is prevalent among patients with schizophrenia across countries in Asia. This study aimed to explore the relationships between psychiatric symptoms and APP using network analysis. Data on nine major psychiatric symptoms and the number of prescribed antipsychotics were extracted from the fourth survey of the Research on Asian Psychotropic Prescription Patterns (REAP-AP). A network model of the nine psychiatric symptoms was constructed for patients treated with APP and antipsychotic monotherapy (APM) respectively. The interconnections between psychiatric symptoms and APP use were further analyzed using network analysis. A total of 1528 patients with schizophrenia treated with APP were matched with 1528 patients treated with APM in Asia. The top three central psychiatric symptoms in the networks of psychiatric symptoms were consistent, but in different orders for APP-treated patients (verbal aggression, hallucinations, and social/occupational dysfunction) and APM-treated patients (social/occupational dysfunction, verbal aggression, and hallucinations). Network analysis of APP and psychiatric symptoms revealed that disorganized/catatonic behavior was strongly linked with APP, followed by delusions, hallucinations, and verbal aggression. Psychiatric symptoms closely associated with APP included verbal aggression, grossly disorganized/catatonic behavior, delusions, and hallucinations. For patients with schizophrenia who are primarily exhibiting such symptoms, alternative appropriate treatment strategies should be considered.
The management of pediatric bipolar disorder (PBD) requires pharmacotherapy to control acute symptoms, reduce relapse, prevent suicide, and improve psychosocial functioning. The purpose of this study was to investigate prescribing patterns among PBD patients discharged from two public mental hospitals in Taiwan, from 2006 to 2019. PBD patients discharged from the two study hospitals, from 1 January 2006 to 31 December 2019 (n = 420), were included in the analysis. Prescribed drugs at discharge, including mood stabilizers (i.e., lithium, valproate, carbamazepine, and lamotrigine), antipsychotics (i.e., second- and first-generation antipsychotics, SGAs and FGAs), and antidepressants, were explored. Complex polypharmacy was defined as the use of 3 or more agents among the prescribed drugs. Time trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test. The most commonly prescribed psychotropic agents were SGAs (76.0%), followed by valproate (65.7%) and FGAs (24.8%). The prescription rates of SGAs, antidepressants, antidepressant plus antipsychotic, and antidepressant without mood stabilizer significantly increased over time, whereas the prescription rates of mood stabilizers, lithium, and FGAs significantly decreased. Prescribing patterns changed greatly for PBD patients over time. However, much more evidence supporting the effectiveness of psychotropic agents in PBD patients is required.
Depression and anxiety are global public health challenges among older adults. Square dancing, a popular activity for older Chinese adults, is believed to relieve these disturbances. This study compared the prevalence, severity, and network structures of depression and anxiety among older square dancers versus non-dancers (i.e., those who do not engage in square dancing). Propensity score matching (PSM) created square dancer and non-dancer groups using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depressive and anxiety symptoms were assessed with the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Central symptoms and bridge symptoms were estimated in each group using expected influence (EI) and bridge EI, respectively. The study included 401 square dancers and a matched sample of 1163 non-dancers. The prevalence and severity of depression and anxiety were significantly lower among square dancers compared to non-dancers. In contrast, network structures of depressive and anxiety symptoms were similar between the two groups. "Uncontrollable worrying" and "Felt sadness" were the most central symptoms, and "Nervousness", "Bothered by things" and "Felt nervous/fearful" were key bridge symptoms across both groups. Participation in square dancing is associated with reduced overall prevalence and severity of depression and anxiety among older adults, but is not associated with a unique network structure of these syndromes compared to non-participation. Consequently, psychosocial interventions developed for depression and anxiety based on the network structure of non-dancers may also be applicable for square dancers who experience anxiety and depression.
Childhood trauma has a significant impact on the development of adolescents, which may lead to interpersonal and psychological problems. Determining the incidence and consequences of childhood trauma in psychiatric clinical practice is of great significance. A survey was conducted among adolescents with mood disorders. Childhood Trauma Questionnaire (CTQ), the Adolescent Non-Suicidal-Self-Injury Behavior Function Assessment Scale (ANBFAS) and a series of psychological scales were filled face to face. Path analysis was used to examine the causation structure of childhood trauma-related symptoms. A total of 117 participants (74.5%) had experienced at least one type of trauma. Interpersonal and psychological features of adolescent patients with childhood trauma were detailed in this study. The path analysis model showed that the relationships between childhood trauma and NSSI were mediated by depressive symptoms and thinking disorders, respectively, whereas depressive symptoms individually mediated the correlation between childhood trauma and sleep disturbances in adolescent patients with psychiatric disorders (χ2 /df = 1.23). For adolescent patients with childhood trauma, psychological counseling for interpersonal relationships should start with families and peers. It is important to treat their depressive symptoms and thinking disorders and alleviate NSSI behavior and sleep disorders.
China has seen rapid urbanization and industrialization in recent decades and children behavioral and emotional problems accompanied have been a heavy burden on family and society. We therefore aimed to estimate the prevalence and risk factors of behavioral and emotional problems in primary school children aged 6-11 in an urbanized area of China. Primary school children aged 6-11 from 15 primary schools were enrolled from Shunde District, Guangdong. The Child Behavior Checklist (CBCL) was used to assess behavioral and emotional problems and then determined risk factors associated with the behavioral and emotional problems. In total, 12 868 were included in the present analysis. The prevalence of total behavioral and emotional problems was 8.4% (95% CI, 7.9%-8.9%), which was gradually increased with age in both boys and girls. The prevalence was higher in boys than girls (9.8% vs. 6.8%, p < .001) and in children without siblings than those with siblings (9.9% vs. 8.1%, p = .006). In boys, age was positively associated with delinquent behavior, depression, poor contact, compulsive activity, social withdrawal, attention problems and aggressive behavior and was negatively associated with schizoid (p < .05). While in girls, age was positively associated with delinquent behavior, somatic complaints, social withdrawal and schizoid/compulsive activity but was negatively associated with aggressive behavior and sexual problems (p < .05). Behavioral and emotional problems are common in primary school children in the urbanized area of China and are associated with sex and siblings. These findings suggest that close attention should be given to these primary school children.
The debate about observing total versus free serum valproate levels for therapeutic drug monitoring (TDM) has been unresolved for decades. This study was planned to assess the agreement between the total versus free valproate levels and the advantage of one method over the other in TDM. The present cross-sectional study was done on 93 patients with bipolar disorder. The intraclass correlation coefficient, Bland Altman analysis, and Lin's concordance analysis were done to assess the agreement between the total and free valproate concentrations. Linear and polynomial models were constructed to evaluate the relation between the two measurements. Receiver operating characteristics analysis was done to compare the accuracy for differentiating remission from non-remission on Young's mania rating scale (YMRS). The intraclass correlation coefficient and Lin's concordance correlation coefficient were 0.491 (p = .002) and 0.055 (95% CI:0.037, 0.073), respectively. Bland Altman's analysis showed proportional bias. A polynomial model of second order was found to be the best fit for the prediction of free valproate from the data for total valproate, and 81.4% of the variability in free valproate could be explained when adjusted for albumin levels. The area under the curve for total valproate was 0.60 when compared to free valproate 0.56 for differentiating between remission and non-remission, but the comparison between the two ROC analyses was not statistically significant. Free valproate does not provide any added advantage over the total valproate levels; hence, total valproate levels may continue to be used as the marker for drug monitoring.
Accumulating evidence indicates that oxidative stress and the disruption of antioxidant defenses play an important role in the neurobiology of bipolar disorder (BD). Studies have found that increased oxidative stress may be associated with cell apoptosis and neuronal damage in BD patients. Hence, this study explored the research field related to BD and oxidative stress from a bibliometrics perspective. Literature search and relevant data retrieval based on the Web of Sciences Core Collection (WoSCC). R software (version 4.2.2), VOSviewer software (version 1.6.18), and CiteSpace (version 6.1.6) were used in this bibliometric analysis. A total of 2081 publications related to BD and oxidative stress were published between 1986 and 2024. Bipolar Disorders was the journal that had the most publications in this area (72; 3.46%; IF = 5.9), while the United States (1285; 61.7%) and the University of Toronto (377; 18.1%) were the most productive country and institution, respectively. Apart from "oxidative stress" and "bipolar disorder," the most frequently used keywords were "schizophrenia," "prefrontal cortex," and "nitric oxide." The growing number of publications related to BD and oxidative stress in recent years highlights the importance of this research field. Hot topics in research related to BD and oxidative stress included animal experiments and molecular mechanisms, psychiatric-related inflammation and biomarkers, neurodegenerative diseases, and metabolism. Furthermore, the biological mechanisms of BD, particularly biomarkers and inflammation, may be the emerging research priority area in the future.
Suicide and early alcohol use initiation are public health concerns. Previous studies have explored the associations between age of alcohol use initiation and suicidal behaviors, which progresses from ideation to action. Distinguishing between the various associations can help gain a deeper understanding of suicidal behaviors and aid in developing social suicide prevention strategies. The study utilized the Youth Risk Behavior Survey to investigate this association. A total of 17 209 students were finally included in the study. Conditional suicidal behaviors included no suicidal behavior (NS), suicidal ideation without a plan or attempt (SINPA), suicide plan without an attempt (SPNA) and suicide attempt (SA). Among 17 209 students, the prevalence of suicidal ideation, suicide plan, and suicide attempt were 21.4%, 17.3%, and 11.1%, respectively. Moreover, 15.2% of the students used alcohol before age 13, whereas 31.7% of students used alcohol at age 13 or older. Compared to NS, students using alcohol showed significant associations with SA (OR = 2.34, p < .001; OR = 1.29, p < .01), SPNA (OR = 1.68, p < .001; OR = 1.19, p < .05) and SINPA (OR = 1.55, p < .001; OR = 1.40, p < .001). Comparing with SINPA and SNPA, students using alcohol before age 13 were associated with SA (OR = 1.61, p < .001; OR = 1.46, p < .001), whereas those using alcohol at or after the age 13 were not associated with SA (OR = 0.98, p > .05; OR = 1.09, p > .05). This study demonstrated that early alcohol use initiation was significantly associated with suicide attempts among students with suicidal ideations or plans.
Previous studies of antidepressant prescribing patterns largely were limited to a single location or time, and very few involved Asia. This Asian Psychotropic Prescription Patterns Consortium study investigated pharmacoepidemiologic trends and factors associated with use and dosing of newer antidepressants across 12 Asian sites in 2003, 2013, and 2023. Data from each site included demographic, treatment setting, clinical features, and type and dosage of antidepressants prescribed. Sociodemographic and clinical variables were examined using univariate methods, followed by multivariable logistic and linear modeling. Of 8357 adult participants (59.8% female), 82.8% received at least one modern antidepressant. Use of these drugs was strongly associated with more recent year, younger age, inpatient status, and affective or anxiety-related disorders. Higher daily antidepressant doses were associated with inpatient status, male gender, more recent year, and younger age. This large, multisite study provides a two-decade overview of evolving antidepressant-prescribing patterns in 12 Asian sites and highlights patient characteristics associated with prescription of newer antidepressants and their dosage. Needed are further studies of psychotropic prescribing practices related to specific illness subtypes and their impact on psychosocial functioning over time among Asian patients.