Bridging clinical needs and economic barriers: a national survey of antidepressant prescribing across 25 hospitals in Thailand.

Authors

Pornjira Pariwatcharakul, Krittisak Anuroj, Nopporn Tantirangsee, Keerati Pattanaseri, Chonnakarn Jatchavala, Nitchawan Kerdcharoen, Papan Thaipisuttikul, Kanthee Anantapong, Lampu Kosulwit, Nuth Graipaspong, Pavarud Puangsri, Poom Chompoosri, Tiyarat Kayankit, Pavita Chongsuksiri, Sirina Satthapisit, Songpon Lodthanong, Amornrut Bangphichet, Veevarin Charoenporn, Saratcha Tiensuntisook, Kamolvisa Techapoonpon, Warut Aunjitsakul, Kantanut Yutrirak, Kritta Supanimitamorn, Tidarat Puranachaikere, Apichat Saengsin, Maneekwan Rujirojsuwan, Orapa Khemtong, Panklow Siriarchawatana, Pawaris Asawalertsaeng, Pawitra Mongkolnaowarat, Pichapuk Jarasrassamee, Ploypan Wangrotjanarat, Tattaporn Suksintaranon, Warith Mongkolnaowarat, Warot Lamyai, Wattanapong Pansawat, Witchuda Chantarat, Pavat Aroonpet, Nutthaporn Jaisamut Sakunphaet, Naratip Sa-Nguanpanich, Lakkana Thongchot, Dutsadee Juengsiragulwit, Burin Suraaroonsamrit, Shih-Ku Lin, Takahiro A Kato, Woraphat Ratta-Apha

Published in

International journal of mental health systems. Jul 06, 2026. Epub Jul 06, 2026.

Abstract

Prescribing patterns are highly influenced by national healthcare structures. This study aimed to investigate the current antidepressant prescribing patterns, associated diagnoses, and the impact of financial barriers on clinical decision-making in Thailand.
We conducted a multicenter national survey on psychotropic drug prescribing across 25 Thai hospitals from December 2023 to March 2024. Utilizing the Research on East Asia Psychotropic Prescription Patterns (REAP-AD3) protocol for antidepressant data, we integrated country-specific modules assessing patient economic burden and physician preferences.
Data from 604 patients were analyzed. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed class (70.2%), followed by tricyclic antidepressants (TCAs) (13.9%) and serotonin antagonist and reuptake inhibitor (SARI) trazodone (12.7%). Most common antidepressant users' diagnoses were depressive disorders (55.0%), followed by substance use (15.2%) and psychotic disorders (13.7%). A substantial number of psychiatrists reported feeling restricted by financial and reimbursement limitations related to each prescription, specifically citing limited drug availability (21.9%, n = 131), the patient's reimbursement scheme (36.3%, n = 217), and the patient's financial status (33.9%, n = 203). In addition, 34.3% (n = 205) indicated that they wanted to change the current prescription if there were not any financial barriers, especially for patients currently on TCAs (49.4%, χ² = 10.16, p = 0.001). Indirect costs per visit (transportation and opportunity costs) frequently exceeded direct monthly medication expenses.
SSRIs were the most commonly prescribed antidepressant in Thailand. However, financial constraints may have contributed to the use of TCAs against clinician preference. Policy revisions addressing both medication access and indirect costs are essential to allow psychiatrists to prescribe antidepressants according to clinical needs, which may sustainably optimize mental health outcomes in Thailand.

PMID:
42410412
Bibliographic data and abstract were imported from PubMed on 07 Jul 2026.

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