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

• Published in: Journal of psychopharmacology (Oxford) 1999-03, Vol.13 (2), p.136-143
• Main Authors: Dunn, Rodney L., Donoghue, John M., Ozminkowski, Ronald J., Stephenson, Deborah, Hylan, Timothy R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Amitriptyline; Antidepressants; Antidepressive Agents - administration & dosage; Antidepressive Agents - adverse effects; Antidepressive Agents, Tricyclic - administration & dosage; Antidepressive Agents, Tricyclic - adverse effects; Biological and medical sciences; Depressive Disorder - drug therapy; Depressive Disorder - epidemiology; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Prescriptions - statistics & numerical data; Drug Utilization; Female; Fluoxetine; Guidelines; Humans; Imipramine; Male; Medical records; Medical sciences; Mental depression; Middle Aged; Neuropharmacology; Paroxetine; Pharmacology. Drug treatments; Practice Guidelines as Topic; Primary Health Care - statistics & numerical data; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Serotonin; Serotonin uptake inhibitors; Serotonin Uptake Inhibitors - administration & dosage; Serotonin Uptake Inhibitors - adverse effects; Sertraline; Treatment Outcome; Tricyclic antidepressants; United Kingdom
• ISSN: 0269-8811; 1461-7285
• DOI: 10.1177/026988119901300204

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