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

AI Summary

SSRIs were the dominant antidepressant class in Thailand (70.2%), with TCAs and trazodone less frequently prescribed.
Financial and reimbursement constraints frequently limited psychiatrists' prescribing choices; 36.3% cited reimbursement scheme, 33.9% patients' finances, 21.9% limited availability.
Indirect visit costs often exceeded monthly medication expenses, prompting 34.3% to want prescription changes absent financial barriers; policy change needed to improve access.

Int J Ment Health Syst. 2026 Jul 6. doi: 10.1186/s13033-026-00719-8. Online ahead of print.

ABSTRACT

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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 | DOI:10.1186/s13033-026-00719-8

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