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This study examines the DDLs\u2019 effects on prescription behavior. Data from 8842 inpatients treated with citalopram or escitalopram with a primary diagnosis of major depressive disorder (MDD) were derived from a European pharmacovigilance study (Arzneimittelsicherheit in der Psychiatrie, AMSP) from 2001 to 2017. It was examined to what extent new maximum doses were adhered to and newly contraindicated combinations with QTc-prolonging drugs were avoided. In addition, the prescriptions of psychotropic drugs before and after DDLs were compared in all 43,480 inpatients with MDD in the data set. The proportion of patients dosed above the new limit decreased from 8 to 1% in patients\u2009\u2264\u200965\u00a0years and from 46 to 23% in patients\u2009&gt;\u200965\u00a0years old for citalopram versus 14\u20135% and 47\u201331% for escitalopram. Combinations of es-\/citalopram with other QTc-prolonging psychotropic drugs reduced only insignificantly (from 35.9 to 30.9%). However, the proportion of patients with doses of quetiapine\u2009&gt;\u2009150\u00a0mg\/day substantially decreased within the combinations of quetiapine and es-\/citalopram (from 53 to 35%). After the DDLs, prescription of citalopram decreased and of sertraline increased. The DDLs\u2019 recommendations were not entirely adhered to, particularly in the elderly and concerning combination treatments. This might partly be due to therapeutic requirements of the included population. Official warnings should consider clinical needs.<\/jats:p>","DOI":"10.1007\/s00406-022-01392-x","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T21:02:42Z","timestamp":1645822962000},"page":"65-74","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Dear Doctor Letters regarding citalopram and escitalopram: guidelines vs real-world data"],"prefix":"10.1007","volume":"273","author":[{"given":"Mateo","family":"de Bardeci","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2342-735X","authenticated-orcid":false,"given":"Waldemar","family":"Greil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Stassen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamila","family":"Willms","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"K\u00f6berle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9","family":"Bridler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Hasler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siegfried","family":"Kasper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eckart","family":"R\u00fcther","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Bleich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sermin","family":"Toto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate","family":"Grohmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Seifert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,2,25]]},"reference":[{"key":"1392_CR1","doi-asserted-by":"publisher","first-page":"255","DOI":"10.3238\/arztebl.2014.0255","volume":"111","author":"S Sch\u00e4chtele","year":"2014","unstructured":"Sch\u00e4chtele S, T\u00fcmena T, Ga\u00dfmann KG, Fromm MF, Maas R (2014) Implementation of warnings from Dear Doctor Letters (Rote-Hand-Briefe): An analysis of medication data from a large cohort of elderly patients. 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SK has received grants\/research support, consulting fees and\/or honoraria within the last three years; grant\/research support from Lundbeck; he has served as a consultant or on advisory boards Celegne, IQVIA, Janssen, Lundbeck, Mundipharma, Recordati, Takeda and Schwabe; and he has served on speakers bureaus for Angelini, Aspen Farmaceutica S.A., Janssen, Krka Pharma, Lundbeck, Medichem Pharmaceuticals Inc., Neuraxpharma, OM Pharma, Pierre Fabre, Sanofi, Servier, Schwabe, and Sun Pharma. JS has taken part in an educational event sponsored by Lundbeck\/Otsuka. ST is a member of the advisory board for Otsuka and Janssen-Cilag and has received speaker\u2019s honoraria from Janssen-Cilag, Lundbeck\/Otsuka, Recordati Pharma GmbH, and Servier. All other authors state they have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"See methods: data source.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}]}}