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

Abstract

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.

Long-Term and Short-Term Antidepressant Use in General Practice: Data from a Large Cohort in the Netherlands

“…Such use rose from 30.3% (1995-2005) to 43.7% (2005-2015). These findings are in line with those in other countries [12,25]. Our estimate of LTU may even be conservative for the Netherlands as a whole.…”

Did NICE guidelines and the Quality Outcomes Framework change GP antidepressant prescribing in England? Observational study with time trend analyses 2003–2013

“…Burton et al (2015) also found longer treatment duration was associated with diagnostic coding, which put patients into the QOF denominator for symptom questionnaire assessment at follow-up as well as diagnosis from 2009 onwards, suggesting the QOF might have increased duration of prescribing for QOF-qualifying cases. However, increased duration of prescribing predates the QOF , and surveys in the USA (where there is no QOF) as well as the UK have consistently found increasing long-term prescribing of antidepressants over the last 10 years, with more than half of patients being treated for two years or more, and a mean duration of treatment of between four and six years (Petty et al, 2006;Pratt et al, 2011;Johnson et al, 2012;Mojtabai and Olfson, 2014).…”

What factors influence long-term antidepressant use in primary care? Findings from the Australian diamond cohort study

“…One large Scottish study using routine data from 78 urban general practices reported a mean length of use of 5.5 years (Johnson et al, 2012). Another US study found that around 60% of Americans taking antidepressant medication reported use for 2 years or longer, with 14% reporting use for 10 years or more (Pratt et al, 2011).…”