A managed care perspective of individualized care.

OBJECTIVE: To examine the concept of individualized care for people with major depressive disorder, understand the drugs currently available, and review the implications of switching drug therapy solely for cost reasons. SUMMARY: The use of antidepressant drugs and their associated costs has been the subject of many pharmacoeconomic analyses. Each particular type of analysis has strengths and weaknesses, and their value can only be determined by stakeholders, all of whom have different perspectives. The development of new and better drugs to treat depression has had a significant impact on the nation.s rate of suicide. For managed care pharmacists, cost is often a concern, especially for patients who are treatment refractory. Studies have demonstrated that attempts to reduce prescription drug use in mental health settings increase other costs in a magnitude of $17 spent for every $1 saved. Adequate treatment, careful cross-tapering, and cultural concerns are addressed. CONCLUSION: Pharmacists who practice in managed care must be cognizant of the implications of inadequate treatment of depression, the potential morbidity and mortality that may result from switching antidepressants based on cost alone, and the most appropriate ways to switch from one drug to another.