Longitudinal patterns of antidepressant prescribing in primary care in the UK: comparison with treatment guidelines

Abstract

The objective of this study was to determine whether patients beginning therapy on the most common tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) differed in their likelihood of having antidepressant treatment that was consistent with recommended treatment guidelines in the UK. An analytical file constructed from a large general practitioner medical records database (DIN-LINK) from the UK for the years 1992-97 was constructed. A total of 16,204 patients with a new episode of antidepressant therapy who initiated therapy on one of the most often prescribed TCAs (amitriptyline, dothiepin, imipramine and lofepramine) or SSRIs (fluoxetine, paroxetine and sertraline) were analysed. A dichotomous measure was defined to indicate whether subjects were prescribed at least 120 days of antidepressant therapy at an adequate average daily dose within the first 6 months after initiation of therapy. Only 6.0% of patients initiating therapy on aTCA and 32.9% of patients initiating therapy on a SSRI were prescribed antidepressant treatment that was consistent with treatment guidelines. After controlling for observable characteristics, patients who initiated therapy on a SSRI were much more likely (odds ratio=7.473, p<0.001) to have a prescribed average daily dose and duration consistent with recommended treatment guidelines within the first 6 months of initiating therapy than were patients who initiated therapy on a TCA. These findings suggest that initial antidepressant selection is an important determinant of whether the subsequent course of treatment is consistent with current national guidelines for the treatment of depression in the UK.

Prescribing Pattern of Antidepressant Drugs among General Practitioners and Psychiatrists: a study from Iran

“…It has been asserted in the mentioned study that 40% of patients with mood disorder (like depression) received no therapeutic intervention during a 12-month period. Another study in England has also emphasized on lower rate of antidepressants prescription in comparison to what has been suggested in their clinical guide [10].…”

Adherence and Subthreshold Adherence in Sleep Apnea Subjects Receiving Positive Airway Pressure Therapy: A Retrospective Study Evaluating Differences in Adherence Versus Use

“…The time line of PAP use for any OSA/UARS patient may emerge in ways similar to the medical practice of attempting to increase the dosage of a drug while both early benefits and adverse effects occur at initial doses, a pattern common to antidepressant medications. 59 Since many patients demonstrate a capacity to endure a therapeutic process more gradually, it seems perplexing that so much emphasis has been placed on an arbitrarily devised adherence construct. Sleep medicine professionals are focused on encouraging greater PAP use and no doubt incorporate naturalistic approaches aligned with patients' learning curves, but adherence rules may interfere with this general practice model of care for select patients.…”

Adherence to Antidepressant Treatment Among Privately Insured Patients Diagnosed With Depression

“…Comorbid medical conditions generally are associated with poor adherence, 20 but findings on age and gender variations are mixed. 15,[20][21][22][23] Use of newer drugs [20][21][22]24 and mental health specialty services 15,16,20,21,25 generally have been associated with better antidepressant adherence. Economic status has rarely been included as an explanatory variable; we identified 1 study, which reported a positive association between income and adherence among veterans.…”