The multicentre survey analysed 604 patients from 25 Thai hospitals between December 2023 and March 2024. SSRIs accounted for 70.2% of prescriptions, followed by TCAs at 13.9% and trazodone at 12.7%. The most common diagnoses were depressive disorders (55.0%), substance use disorders (15.2%) and psychotic disorders (13.7%). Clinicians cited limited availability (21.9%), reimbursement arrangements (36.3%) and patient finances (33.9%) as prescribing constraints.
Key findings
- Clinicians would have changed the current prescription for 34.3% of patients if financial barriers were absent. This preference was especially common among current TCA users (49.4%; χ²=10.16, p=0.001). Transport and opportunity costs per visit frequently exceeded direct monthly medicine costs.
Why this matters globally
The study adds health-system evidence from a middle-income setting to the global discussion on equitable mental-health care. It shows that formularies and reimbursement cannot be considered separately from travel, time and lost-income costs. It informs policy design but does not prove that one antidepressant class is clinically superior for every patient.
Thai researcher contribution
This is a broad Thailand-led network spanning 25 hospitals, universities, the Ministry of Public Health and regional services. Thai investigators shaped the research question, collected national data and interpreted prescribing constraints within the Thai health system.
Limitations to consider
The cross-sectional design captures associations and stated preferences, not causal effects. It did not follow symptoms, effectiveness, adverse events or adherence. Participating hospitals and sampled patients may not represent every level of Thai mental-health care.