Antidepressant prescription patterns and CNS polypharmacy with antidepressants among children, adolescents, and young adults: a population-based study in Sweden

Abstract

This study examines trends in antidepressant drug dispensations among young people aged 0–24 years in Sweden during the period 2006–2013, as well as prescription patterns and central nervous system (CNS) polypharmacy with antidepressants. Using linkage of Swedish national registers, we identified all Swedish residents aged 0–24 years that collected at least one antidepressant prescription (here defined as antidepressant users) between 1 January 2006 and 31 December 2013 ( n = 174,237), and categorized them as children (0–11 years), adolescents (12–17 years), and young adults (18–24 years). Prevalence of antidepressant dispensation rose from 1.4 to 2.1% between 2006 and 2013, with the greatest relative increase in adolescents [by 97.8% in males (from 0.6 to 1.3%) and by 86.3% in females (from 1.1 to 2.1%)]. Most individuals across age categories were prescribed selective serotonin reuptake inhibitors, received their prescriptions from psychiatric specialist care, and had treatment periods of over 12 months. Prevalence of CNS polypharmacy (dispensation of other CNS drug classes in addition to antidepressants) increased across age categories, with an overall increase in prevalence from 52.4% in 2006 to 62.1% in 2013. Children experienced the largest increase in polypharmacy of three or more psychotropic drug classes (4.4–10.1%). Anxiolytics, hypnotics, and sedatives comprised the most common additional CNS drug class among persons who were prescribed antidepressants. These findings show that the dispensation of antidepressants among the young is prevalent and growing in Sweden. The substantial degree of CNS polypharmacy in young patients receiving antidepressants requires careful monitoring and further research into potential benefits and harms. Electronic supplementary material The online version of this article (10.1007/s00787-018-01269-2) contains supplementary material, which is available to authorized users.

Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998–2017: A population-based cohort study

“…Antidepressant prescriptions for young people were increasing until a drop in 2002, and then began significantly increasing again from 2005 both in the UK [15][16][17][18][19] and other countries [20][21][22][23]. Increased prescribing of antidepressants could indicate a greater awareness and recognition of mental health and related issues and a willingness to seek help in the form of being diagnosed and/or treated.…”

Patterns of Antidepressant Prescriptions for the Treatment of Depression: A Scoping Review

“…The total sample size was 1,88,713 patients. The studies were conducted in Sweden 25 More males were receiving antidepressants (57.86%).…”

“…We identi ed fteen studies through this review, and the majority of the patients were in the economically productive age group of 40-50 years [25][26][27][28][29][30][31][32][34][35][36][37][38][39] , whereas in the result of a study on antidepressant use in Italy, the mean age of the patients who received antidepressant prescriptions was more than 50 years 33 .…”

“…Medical treatment of depression not only improves the mental health of patients but also increases their physical and social performance, making them optimistic and encouraged towards life 34 . Our review revealed that SSRIs are the dominant antidepressants prescribed over TCAs, SNRIs, and other atypical antidepressants for the treatment of depression [25][26][27][28][29][31][32][33][34][35][36][37][38][39] . The frequent use of SSRIs could be because of the advantages they offer.…”

Associations between selective serotonin reuptake inhibitors and violent crime in adolescents, young, and older adults – a Swedish register-based study

“…Mood disorders are leading contributors to disease burden globally ( Vos et al., 2016 ) and, if left untreated, lead to substantial morbidity and mortality ( Rapaport et al., 2005 ; Rihmer, 2007 ; Stewart et al., 2003 ). Antidepressant medications are a major part of the treatment of these disorders – and selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed type in a number of countries ( Abbing-Karahagopian et al., 2014 ; Mars et al., 2017 ; Mojtabai and Olfson, 2014 ), where their use has been increasing across age groups over the last two decades ( Abbing-Karahagopian et al., 2014 ; Lagerberg et al., 2019 ; Pratt et al., 2011 ). For example, in the US, the population prevalence of antidepressant use increased from 6.5% in 1999–2000 to 10.4% in 2009–2010, with almost two-thirds of those prescribed antidepressants being treated with SSRIs in 1999–2010 ( Mojtabai and Olfson, 2014 ).…”