Cross sectional database analysis of antidepressant prescribing in general practice in the United Kingdom, 1993-5

Donoghue, J.; Tylee, André; Wildgust, Hiram J

doi:10.1136/bmj.313.7061.861

Cited by 74 publications

(55 citation statements)

References 3 publications

(5 reference statements)

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“…5 The 47.1% of patients prescribed long-term antidepressants is comparable with other studies of 48% 30 and 40.6-51.4%, 7 however the mean PDD of SSRIs are substantially higher than previously reported, 4,[15][16][17] suggesting a tendency to 'push the dose' in these CHCPs.…”

Section: Strengths and Limitationssupporting

confidence: 69%

“…The pre-review average PDDs of the majority of antidepressants are higher than previously reported in literature, 4,[15][16][17] with SSRI doses 10-30% higher.…”

Section: Discussioncontrasting

confidence: 48%

“…9,10,24,25 Historically GPs prescribed subtherapeutic doses of tricyclic antidepressants (TCAs) 14,15,27 and over the years campaigns 40 and guidelines 9,10,41 have supported a message to prescribers to increase antidepressant doses to achieve better patient response and remission of depressive symptoms. This message is appropriate for TCAs and venlafaxine whose efficacy increases as dose increases, 9,10,24,25 but not for SSRIs where it may be more efficacious to change compliant non-and poor-SSRI responders to a different SSRI rather than increasing the dose.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…11 In response, the NHS Greater Glasgow and Clyde (NHS GG&C) Health Board committed to GPs reviewing long-term antidepressant prescribing in four community health and care partnerships (CHCPs), as medication review demonstrably reduces inappropriate prescribing and costs. [12][13][14][15] NHS GG&C also knew that six GP practices had higher average prescribed daily doses (PDD) of selective serotonin re-uptake inhibitors (SSRIs) than reported in current literature, 4,[15][16][17] therefore PDDs were also of interest as SSRIs account for half of all antidepressant prescriptions. 5 The aim of this study was to review general practice patients prescribed the same antidepressant for ≥2 years, and describe prescribing and management pre and post-review.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study

Johnson¹,

Macdonald²,

Atkinson³

et al. 2012

Br J Gen Pract

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BackgroundAntidepressant prescribing continues to rise. Contributing factors are increased long-term prescribing and possibly the use of higher selective serotonin re-uptake inhibitor (SSRI) doses. AimTo review general practice patients prescribed the same antidepressant long-term (≥2 years) and evaluate prescribing and management pre and post-review. Design and settingProspective observational cohort study using routine data from 78 urban general practices, Scotland. MethodAll patients prescribed antidepressants (excluding amitriptyline) for ≥2 years were identified from records November 2009 to March 2010. GPs selected patients for face-to-face review of clinical condition and medication, December 2009 to September 2010. Pre-and post-review data were collected; average antidepressant doses and changes in prescribed daily doses were calculated. Onward referral to support services was recorded. Results8.6% (33 312/388 656) of all registered patients were prescribed an antidepressant, 47.1% (15 689) were defined as long-term users and 2849 (18.2%) were reviewed. 811 (28.5%) patients reviewed had a change in antidepressant therapy: 7.0% stopped, 12.8% reduced dose, 5.3% increased dose, and 3.4% changed antidepressant, resulting in 9.5% (95% CI = 9.1% to 9.8% P<0.001) reduction in prescribed daily dose and 8.1% reduction in prescribing costs. 6.3% were referred onwards, half to NHS Mental Health Services. Pre-review SSRI doses were 10-30% higher than previously reported. ConclusionAlmost half of all people prescribed antidepressants were long-term users. Appropriate reductions in prescribing can be achieved by reviewing patients. Higher SSRI doses may be contributing to current antidepressant growth.

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Section: Strengths and Limitationssupporting

confidence: 69%

“…The pre-review average PDDs of the majority of antidepressants are higher than previously reported in literature, 4,[15][16][17] with SSRI doses 10-30% higher.…”

Section: Discussioncontrasting

confidence: 48%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study

Johnson¹,

Macdonald²,

Atkinson³

et al. 2012

Br J Gen Pract

View full text Add to dashboard Cite

show abstract

“…According to Italian researchers, if the restriction of first-choice drugs were revoked, the use of antidepressants would change, resulting in the higher prescribing rates for SSRI and newer AD group (17). Due to high toxicity of TCAs, these antidepressants are used less frequently and for shorter period than recommended (18)(19)(20). However, SSRIs are not proven to be as effective as TCAs in hospitalized patients (21).…”

Section: Discussionmentioning

confidence: 99%

Analysis of antidepressant prescribing tendencies in Lithuania in 2003–2004

Jakimavičius¹,

Sveikata

Vainauskas³

et al. 2007

Medicina

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Treating Major Depression in Primary Care Practice

Schulberg

Katon

Simon

et al. 1998

Arch Gen Psychiatry

429

205

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The Depression Guideline Panel of the Agency for Health Care Policy and Research in 1993 published recommendations for treating major depression in primary care practice that were often based on studies of tertiary care psychiatric patients. We reviewed reports of randomized controlled trials in primary care settings published between 1992 and 1998. This evidence indicates that both antidepressant pharmacotherapy and time-limited depression-targeted psychotherapies are efficacious when transferred from psychiatric to primary care settings. In most cases, the choice between these treatments should depend on patient preference. Studies to date suggest that improving treatment of depression in primary care requires properly organized treatment programs, regular patient follow-up, monitoring of treatment adherence, and a prominent role for the mental health specialist as educator, consultant, and clinician for the more severely ill. Future research should focus on how guidelines are best implemented in routine practice, since conventional dissemination strategies have little impact.

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Cross sectional database analysis of antidepressant prescribing in general practice in the United Kingdom, 1993-5

Cited by 74 publications

References 3 publications

Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study

Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study

Analysis of antidepressant prescribing tendencies in Lithuania in 2003–2004

Treating Major Depression in Primary Care Practice

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