Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database

Moore, Michael; Yuen, Ho Ming; Dunn, Nick; Mullee, Mark; Maskell, Joe; Kendrick, Tony

doi:10.1136/bmj.b3999

Cited by 238 publications

(239 citation statements)

References 16 publications

Supporting

Mentioning

213

Contrasting

Unclassified

Order By: Relevance

“…8 Data from the present study suggest better adherence to treatment than in three recent reports using comparable routine care data from England, 2 Spain, 15 and the US. 16 In contrast to at least one of these studies, 15 the present study found no clinically important difference in duration of treatment between males and females, and little difference between first-ever and subsequent treatment, suggesting a consistent approach to prescribing by GPs.…”

Section: Comparison With Existing Literaturecontrasting

confidence: 53%

“…2,3 Data in this study related to all prescriptions for antidepressants commonly used to treat depression in primary care. Unlike the findings of Moore et al, 8 this research did not limit the study to patients with a computer-coded diagnosis of depression; thus the sample includes those issued an antidepressant for an anxiety disorder and those without a formally coded diagnosis.…”

Section: Comparison With Existing Literaturementioning

confidence: 78%

See 1 more Smart Citation

Factors associated with duration of new antidepressant treatment: analysis of a large primary care database

Burton¹,

Anderson²,

Wilde³

et al. 2012

Br J Gen Pract

View full text Add to dashboard Cite

Section: Comparison With Existing Literaturecontrasting

confidence: 53%

Section: Comparison With Existing Literaturementioning

confidence: 78%

Factors associated with duration of new antidepressant treatment: analysis of a large primary care database

Burton¹,

Anderson²,

Wilde³

et al. 2012

Br J Gen Pract

View full text Add to dashboard Cite

“…17 Similar accounts of dissonance between the medical and social model of depression have been recorded. 6,7,18,19 Research examining late-life depression suggests that patients are more comfortable accepting depression and taking antidepressants for a 'normal' chronic condition rather than a social or psychiatric condition, hence the predilection to understand the condition in physical terms. 18 Barriers to discontinuation, such as fear of withdrawal, discontinuation symptoms, and a lack of alternative treatments have been attested.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Long-term prescribing of antidepressants in the older population: a qualitative study

Dickinson

Knapp²,

House³

et al. 2010

Br J Gen Pract

124

View full text Add to dashboard Cite

MethodThirty-six patients aged ≥75 years and 10 GPs were interviewed. Patients were sampled to ensure diversity in age, sex, antidepressant type, and home circumstances. ResultsParticipants perceived significant benefits and expressed little apprehension about taking long-term antidepressants, despite being aware of the psychological and social factors involved in onset and persistence of depression. Barriers to discontinuation were identified following four themes: pessimism about the course and curability of depression; negative expectations and experiences of ageing; medicine discontinuation perceived by patients as a threat to stability; and passive (therapeutic momentum) and active (therapeutic maintenance) decisions to accept the continuing need for medication. ConclusionThere is concern at a public health level about high rates of long-term antidepressant prescribing, but no evidence was found of a drive for change either from the patients or the doctors interviewed. Any apprehension was more than balanced by attitudes and behaviours supporting continuation. These findings will need to be incorporated into the planning of interventions aimed at reducing long-term antidepressant prescribing in older people. Keywordsantidepressants; prescribing; attitudes. INTRODUCTIONA previous study of antidepressant prescribing in the UK reported high rates of long-term prescribing. For patients aged ≥75 years, 14% were being prescribed an antidepressant, while the rate in those aged <75 years was less than half that (6%). 1Among patients aged ≥75 years prescribed an antidepressant, almost half (48%) had been in receipt of a prescription for more than 2 years. Few patients' records had evidence of medication review or discussion of possible withdrawal.Depression is common in later life, 2,3 but it is not clear why the rates of prescribing, and of long-term prescribing in particular, appear to be so much higher in patients aged ≥75 years. 4 Most older patients with depression are managed in primary care by their GP. Guidance regarding the management of depression in the UK is provided by the National Institute for Health and Clinical

show abstract

“…The sample probably includes patients likely to be compliant with treatment and the rate of antidepressant prescribing (98%) is higher than that seen in other observational primary care data (80%). 15 As it is not possible to comment on the treatment of those with a single PHQ-9 measure, or draw conclusions with regard to the management of depression in patients who were not followed up, the data should not be taken to represent the global treatment of depression in primary care.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Depression management in primary care: an observational study of management changes related to PHQ-9 score for depression monitoring

Moore

Ali²,

Stuart³

et al. 2012

Br J Gen Pract

View full text Add to dashboard Cite

BackgroundSince 2009 UK GPs have been incentivised to use depression severity scores to monitor patients' response to treatment after 5-12 weeks of treatment. AimTo examine the association between the severity scores obtained and follow-up questionnaires to monitor depression and subsequent changes made to the treatment of it. Design and settingA retrospective cohort study utilising routine primary care records was conducted between April 2009 and March 2011 in 13 general practices recruited from within Hampshire, Wiltshire, and Southampton City primary care trusts. MethodRecords were examined of 604 patients who had received a new diagnosis of depression since 1 April 2009, and who had completed the nineitem depression scale of the Patient Health Questionnaire (PHQ-9) at initial diagnosis and a subsequent PHQ-9 within 6 months. The main outcome measure was the odds ratio (OR) for a change in depression management. Change in management was defined as change in antidepressant drug prescription, dose, or referral. ResultsControlling for the effects of potentially confounding factors, patients who showed an inadequate response in score change at the time of second assessment were nearly five times as likely to experience a subsequent change to treatment in comparison with those who showed an adequate response (OR 4.72, 95% confidence interval = 2.83 to 7.86). ConclusionGPs' decisions to change treatment or to make referrals following a second PHQ-9 appear to be in line with guidance from the National Institute for Health and Clinical Excellence for the monitoring of depression in primary care. Although the present study demonstrates an association between a lack of change in questionnaire scores and treatment changes, the extent to which scores influence choice and whether they are associated with improvements in depression outcomes is an important area for further research. Keywords depression; patient monitoring; primary care.

show abstract

Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database

Cited by 238 publications

References 16 publications

Factors associated with duration of new antidepressant treatment: analysis of a large primary care database

Factors associated with duration of new antidepressant treatment: analysis of a large primary care database

Long-term prescribing of antidepressants in the older population: a qualitative study

Depression management in primary care: an observational study of management changes related to PHQ-9 score for depression monitoring

Contact Info

Product

Resources

About