Abha Thakurdesai1, Sagar Karia1, Suhas Satish2, Devavrat Harshe3, Adarsh Tripathi4. 1. Department of Psychiatry, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India. E-mail: abha209@gmail.com. 2. Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. 3. Department of Psychiatry, D.Y. Patil Hospital, Kolhapur, Maharashtra, India. 4. Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India.
Sir,The PACECAR study[1] is pathbreaking; for the first time, antidepressant drug compliance in rural India has been a subject of study. We wish to offer some comments on the methods and findings of the study.The sample recruitment was not naturalistic; therefore, we wonder whether patients would have behaved naturalistically. Next, it is not clear whether attempts were made to improve compliance such as through patient education about efficacy and adverse effects, or whether attempts were made to improve tolerability through the use of adjunctive psychopharmacological treatments. These are also naturalistic interventions.The sample should have been better described; the age data appear incomplete. Of interest, different drugs were escalated to therapeutic or peak doses after different intervals, and this could have influenced their efficacy and tolerability. Finally, we suggest that decision-making and assessments could have been made objective such as through the use of simple and easy-to-use instruments such as the Clinical Global Impression scales for severity and improvement.
Authors: T S Sathyanarayana Rao; J Shivanand Manohar; Rajesh Raman; M S Darshan; Abhinav Tandon; K N Karthik; N Saraswathi; Keya Das; G T Harsha; Swetha Patil Kunkeri; Chittaranjan Andrade Journal: Indian J Psychiatry Date: 2017 Apr-Jun Impact factor: 1.759