RT Journal Article
SR Electronic
T1 Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e773
OP e779
DO 10.3399/bjgp12X658304
VO 62
IS 604
A1 Chris F Johnson
A1 Hector J Macdonald
A1 Pauline Atkinson
A1 Alasdair I Buchanan
A1 Noreen Downes
A1 Nadine Dougall
YR 2012
UL http://bjgp.org/content/62/604/e773.abstract
AB Background Antidepressant prescribing continues to rise. Contributing factors are increased long-term prescribing and possibly the use of higher selective serotonin re-uptake inhibitor (SSRI) doses.Aim To review general practice patients prescribed the same antidepressant long-term (≥2 years) and evaluate prescribing and management pre and post-review.Design and setting Prospective observational cohort study using routine data from 78 urban general practices, Scotland.Method All 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.Results 8.6% (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.Conclusion Almost 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.