A drug utilisation study of antidepressants in children and adolescents using the General Practice Research Database

Abstract

were identified from the UK General Practice Research Database. Prescribing patterns, annual prevalence, morbidity patterns, and time to discontinuation of ATD use were identified. Results: A total of 24 976 subjects received 93 091 prescriptions; 51 868 (55.7%), 38 429 (41.3%), and 2708 (2.9%) prescriptions were for tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and other ATDs respectively. ATD prevalence increased 1.7-fold from 1992 to 2001. TCA prevalence decreased by 30% from 3.6 to 2.5 per 1,000; SSRI prevalence increased 10 times from 0.5 to 4.6 per 1,000. In new ATD users aged (10 years, the most common diagnosis associated with TCA use was nocturnal enuresis (75.1%); in those aged >15 years, it was depression (45.8%). Depression was also associated with SSRI use (69.0%). For new users with depression, the median treatment durations for TCAs and SSRIs were 30 and 58 days respectively. TCA users were more likely to terminate treatment than SSRI users (TCAs v fluoxetine: 1.40, 95% CI 1.32 to 1.47; non-fluoxetine SSRIs v fluoxetine: 1.01, 95% CI 0.96 to 1.07). Conclusions: SSRIs have gained popularity for the treatment of depression compared with TCAs. TCAs are still used despite their lack of efficacy in prepubertal depression and their moderate effect in adolescents. However, .50% of subjects discontinue treatment after two months, with TCA users stopping earlier than SSRI users. S elective serotonin reuptake inhibitors (SSRIs) were first introduced in the late 1980s, and they have been used increasingly in children following studies showing their effectiveness in adult psychiatric disorders 1 and trials showing the ineffectiveness of tricyclic antidepressants (TCAs) in childhood depression.2 Some randomised placebo controlled trials (RCTs) of SSRIs in the treatment of paediatric depressive disorders, anxiety, and obsessive-compulsive disorder (OCD) show efficacy. [3][4][5][6][7][8]

Trends in Psychostimulant and Antidepressant Use by Children in 2 Canadian Provinces

“…Moreover, our observations are similar to those from a UK study demonstrating a 70% increase in AD use among children between 1992 and 2001. 20 Additionally, trends in AD use according to age and sex were consistent among children from both provinces. We note a more pronounced increase in AD use among females, compared with males over the study period, consistent with observations from the recent US study.…”

“…2 Second, the trend of increased psychotropic use has been observed among children less than 6 years old, 15,16 although others suggest that treatment in this age group is initiated only in conjunction with psychosocial services in children with predisposing risk factors. 17 More recent studies have demonstrated a continued rise in the use of psychotropics among children and adolescents both in the United States [3][4][5]18,19 and in Europe, 20,21 and these trends are seen for psychostimulants 3,4 and ADs. 5,19,20 However, there is much less data among Canadian children.…”

“…17 More recent studies have demonstrated a continued rise in the use of psychotropics among children and adolescents both in the United States [3][4][5]18,19 and in Europe, 20,21 and these trends are seen for psychostimulants 3,4 and ADs. 5,19,20 However, there is much less data among Canadian children. Several studies have examined psychotropic drug use on a provincial level, including data from BC, 22 Ontario, 23 and MB, 24,25 although most of the studies to date have focused exclusively on methylphenidate use.…”

Rise in antiobesity drug prescribing for children and adolescents in the UK: a population‐based study

“…Data held include subject demographic and clinical details including data on drug prescriptions and comorbid conditions.The quality of the GPRD data has been validated in a number of studies,the completeness of medical recording is reported to be high [14],and the GPRD has been used to investigate paediatric prescribing issues [12,13].…”

“…National primary care databases provide useful sources of paediatric prescribing data in the UK [12,13]. Although NICE guidance recommends that antiobesity drugs for children and adolescents be initiated from secondary care in the UK [9], routine practice is for general practitioners (GPs) to prescribe after recommendation from paediatricians.…”