Footnotes Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Conflict of interest statement: The authors declare no conflicts of interest in preparing this article. Contributor Cyclosporin A Information Jayaraman Hariram, Institute of Mental Health, Singapore. Yogaratnam
Jegan, Institute of Mental Health, 10 Buangkok View, Singapore 539747.
The prescription of psychotropic Inhibitors,research,lifescience,medical medicines across all age groups is rising worldwide [Wong et al. 2004; Exeter et al. 2009; Deambrosis et al. 2010; Verdoux et al. 2010; Ilyas and Moncrieff, 2012], comprising a US$330 billion market [Murashev, 2012], more than Inhibitors,research,lifescience,medical a third of global pharmaceutical sales. In the US antidepressants comprise the largest category of prescribed
drug ranked by expenditure, and their use continues to increase by around 20% each year. The prescription of antipsychotic medicines, 13th by expenditure, is increasing even more rapidly [Zuvekas, 2005]. In England, the estimated health, social and informal care cost for mental illness was £22.5 billion per annum in 2007 [McCrone, 2008]. Within this, psychotropic medication is a significant area of growth, as antidepressant prescriptions have increased by 10% and antipsychotics by 5% year on year [Ilyas and Moncrieff, 2012]. Inhibitors,research,lifescience,medical In 2010 they accounted for almost 9% of all prescriptions. Multiple factors have contributed to Inhibitors,research,lifescience,medical these trends. Medical practice is changing; in psychiatry, new and more expensive antidepressants and antipsychotics have superseded old ones and, crucially, more people are being
treated and prescribed for [Zuvekas, 2005]. Public health demographics are changing; the number of people with chronic conditions is rising [Busse et al. 2010] and as life expectancy improves the ‘at risk pool’ for many disorders increases [Winker and Deangelis, 2010]. Pharmaceutical advertising is becoming increasingly targeted, not only at the prescriber, but also at the patient or consumer [Donohue et al. 2007]. The licensing process One of the Inhibitors,research,lifescience,medical key controls of medicines use is the licensing process, with prescribing practices beyond this known as off-licence or ‘off-label’. In the UK a drug’s marketing authorization specifies its licensed dose range, form and target disorders, a role performed by the Medicines and Healthcare products Regulatory Agency (MHRA) and the Food and Drug Administration (FDA) in the Montelukast Sodium US. These agencies are primarily concerned with defining the market entry requirements of medicines rather than policing future prescribing practices. In the UK the MHRA process for licensing medicines before they come to market is governed by UK and European Union law. The MHRA assess the quality, safety and efficacy data submitted to it from human clinical trials determined, designed and conducted by the pharmaceutical companies.