Increase In Antidepressant Prescribing Research Articles

National level prescribing of psychotropic medication in primary care during the COVID-19 pandemic in England: potential implications for cardiometabolic health.

The COVID-19 (SARS-CoV-2) pandemic has had a global impact on healthcare provision. Changes in prescribing of commonly used medications can be used as a marker for diagnoses of new patients as well as measuring service levels for patients in primary care [1]. The consequences of the COVID-19 pandemic in relation to incident cases of depression and other mental health issues are well documented [2–4]. How much the prescribing of specific psychotropic medications was impacted by the pandemic has been less explored. This is relevant from a cardiovascular point of view as untreated depression and untreated psychosis are associated with a signficantly elevated cardiovascular event rate [5,6]. We here compare prescribing data for psychotropic medication with common physical health medications in England before/during the COVID-19 pandemic. Primary Care Prescribing data for different major national formulary classes of drug from March 2017 to February 2022 (5 years) were considered [7]. In order to capture the impact during periods of social restriction of access to health services for new diagnoses/existing conditions, repeat prescriptions and episodic prescribing were included with account taken of historical trend. The prepandemic prescriptions issued each month from March 2017 to February 2020 were linearly extrapolated forward to give estimates over the pandemic period to give an expected annual growth (EAG). From this the monthly average expected prescriptions for the pandemic period March 2020–February 2022 were calculated and compared to the actual average. The change in share of total prescriptions of the main antidepressantant medications was evaluated to show relative change. As comparative baseline, it was found that physical health medications had lower monthly prescription during the pandemic with antibiotic (which are episodic) −12.2% (EAG −1.4%), and the most repeat prescriptions for bronchodilators −1.8% (EAG 0%), hypertension and heart failure −1.3% (EAG 1%), and lipid regulating minimally less at −0.1% (EAG 2.3%). Mental Health monthly prescribing increased with hypnotics/anxiolytics by 0.6%(EAG −2.4%), antipsychotics by 0.5% (EAG 2.7%), and antidepressants up by 0.3% (EAG 4.9%) The profile of the three main antidepressant medications was: sertraline increased from 22.7 to 24.6% (+8%), mirtazapine increased from 13.0 to 13.6% (+5%), and venlafaxine stayed at 6.3% (0%). The pandemic effect on psychotropic prescribing was not as large as might be expected, possibly impacted by limited access to services [8]. The fall in antibiotic prescribing may similarly reflect the impact of reduced access to services, limiting episodic prescribing. The increase in anxiolytic/hypnotic and antidepressant prescribing above trend links to pandemic effects on anxiety/worry [2–4]. However, the increase is far from what might be expected, on the basis of what is known about the way that the COVID-19 pandemic resulted in increased rates of anxiety and depression in the UK population as elsewhere in the world [2,3.4]. The slight increase in antipsychotic prescribing likely relates to the use of antipsychotics in care home settings [9] and is additive to the trend before the pandemic for increased prescribing of antipsychotic medication in England [10]. Should our assertion that the increase in antidepressant prescribing be much less than anticipated, the inference is that depression has been underdiagnosed in England and possibly elsewhere. If untreated, depression is associated with an adverse cardiovascular profile [5,6] and poorer life/socioeconomic/health outcomes overall [11] Going forward, an evaluation of individuals’ experiences might illuminate why we have observed these prescribing trends. It is hoped that we can use the opportunity created by the COVID-19 pandemic to enable sustained, efficient, and equitable delivery of mental healthcare with attendant benefits for cardiovascular outcome in those affected by enduring mental health conditions [12]. Acknowledgements All authors contributed equally and substantially to the cocreation and writing of this paper. Data availability statement: the data that support the findings of this study are available from the corresponding author upon reasonable request. Conflicts of interest There are no conflicts of interest.

Don't get fooled again.

According to William Osler, ‘The desire to take medicine is perhaps the greatest feature which distinguishes man from animals’ . When I was a medical student we were taught about the dangers and evils of barbiturates. But fortunately we now had the safer and non-addictive benzodiazepines. By the time I was a GP I was busy weaning patients off those same benzodiazepines. And then came the ‘Defeat Depression’ (DDC) campaign of the 1990s, which led to a huge increase in antidepressant prescribing. The percentage of the UK population prescribed an antidepressant rose from 8.0% in1995/1996 to 13.4% in 2006/2007.2 We GPs were woefully neglecting our patients by not identifying depression and …

Depression omitted from new medicine service extension despite increase in antidepressant prescribing during pandemic

Depression omitted from new medicine service extension despite increase in antidepressant prescribing during pandemic

The EU referendum and mental health in the short term: a natural experiment using antidepressant prescriptions in England

BackgroundPrevious research has highlighted the impact of economic conditions and uncertainty on physical and mental health. The unexpected result of the Brexit referendum in 2016 triggered high levels of economic...

Influences on antidepressant prescribing trends in the UK: 1995\u20132011

PurposeThe number of antidepressants prescribed in the UK has been increasing over the last 25 years; however, the reasons for this are not clear. This study examined trends in antidepressant prescribing in the UK between 1995 and 2011 according to age, sex, and drug class, and investigated reasons for the increase in prescribing over this period.MethodsThis is a retrospective analysis of antidepressant prescribing data from the Clinical Practice Research Datalink: a large, anonymised, primary care database in the UK. The dataset used in this study included 138 practices, at which a total of 1,524,201 eligible patients were registered across the 17-year period. The proportion of patients who received at least one antidepressant prescription and the number of patients who started a course of antidepressants were calculated for each year of the study. We used person years (PY) at risk as the denominator. The duration of treatment for those starting antidepressants was also examined.Results23% of patients were prescribed an antidepressant on at least one occasion over the 17-year study period. Antidepressant prescriptions rose from 61.9 per 1000 PY in 1995 to 129.9 per 1000 PY in 2011. This was largely driven by an increase in prescribing of selective serotonin reuptake inhibitors and ‘other’ antidepressants. In contrast, incidence rates of those starting antidepressants remained relatively stable (1995: 21.3 per 1000 PY; 2011: 17.9 per 1000 PY). The duration of treatment increased with later starting years, with an increasing proportion of long-term use, and decrease in short-term use.ConclusionThe increase in antidepressant prescribing over the study period appears to be driven by an increase in long-term use of these medications.

Sales of antidepressants, suicides and hospital admissions for depression in Veneto Region, Italy, from 2000 to 2005: an ecological study

BackgroundIncreased prescription of antidepressants has been consistently associated with a decrease in suicide rates in several countries. The aim of this study is to explore antidepressant consumption, suicide rates and admission for depression in the Veneto Region, Italy, in order to see whether the same pattern could be detected.MethodsData from the Italian Ministry of Health (admissions for depression), the Pharmacy Service of a Local Health Unit (antidepressant prescribing) and from the Epidemiological System of the Veneto region (suicide rates) were collected from 2000 to 2005 for the Veneto region.ResultsSuicide rates did not show any marked increase but were stable in males and females. Antidepressant prescribing increased exponentially over the period examined, whilst admissions for depression markedly decreased. The trend for an exponential increase in antidepressant prescribing in the Veneto region is shared with other countries and locales.ConclusionsIt is possible that the increase in antidepressant prescribing might be associated with earlier treatment of depression, thus decreasing the likelihood of aggravation of depression.

‘A coal face option’: GPs' perspectives on the rise in antidepressant prescribing

Levels of antidepressant prescribing have dramatically increased in Western countries in the last two decades. To explore GPs' views about, and explanations for, the increase in antidepressant prescribing in Scotland between 1995 and 2004. Qualitative, interview study. General practices, Scotland. GPs in 30 practices (n = 63) purposively selected to reflect a range of practice characteristics and levels of antidepressant prescribing. Interviews with GPs were taped and transcribed. Analysis followed a Framework Approach. GPs offered a range of explanations for the rise in antidepressant prescribing in Scotland. Few doctors thought that the incidence of depression had increased, and many questioned the appropriateness of current levels of prescribing. A number of related factors were considered to have contributed to the increase. These included: the success of campaigns to raise awareness of depression; a willingness among patients to seek help; and the perceived safety of selective serotonin reuptake inhibitors, making it easier for GPs to manage depression in primary care. Many GPs believed that unhappiness, exacerbated by social deprivation and the breakdown of traditional social structures, was being 'medicalised' inappropriately. Most antidepressant prescriptions in Scotland are issued by GPs, and current policy aims to reduce levels of prescribing. To meet this aim, GPs' prescribing behaviour needs to change. The findings suggest that GPs see themselves as responders to, rather than facilitators of, change and this has obvious implications for initiatives to reduce prescribing.

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

Objective To explore the reasons behind the recent increase in antidepressant prescribing in the United Kingdom.Design Detailed retrospective analysis of data on general practitioner consultations and antidepressant prescribing.Data source Data...

Antidepressant Prescriptions Are on the Rise in the U.S.

Antidepressants have surpassed antihypertensive medications as the most frequently prescribed medication class for outpatients. These researchers determined the increase in antidepressant prescribing in various socioeconomic groups through community-based surveys of 18,993 people in 1996 and 28,445 people in 2005 in the U.S. The investigators used multiple interviews and confirmed respondents' self-reported data with …

Vigilance Needed in Recognizing Behavior Changes in Patients Taking Statins

Sir: Evidence from randomized trials suggests that statins are very safe.1 Consequently, their widespread use is highly promoted, even in high doses, and among adults of all ages. However, we feel caution is warranted, particularly when striving for aggressive low-density lipoprotein (LDL) cholesterol targets. In general, subjects in statin trials have been free of many chronic diseases, such as prevalent cancer, severe renal impairment, and neurodegenerative and depressive disorders. In clinical practice, individuals with the aforementioned problems and other chronic ailments are commonly treated with statins to achieve LDL cholesterol–lowering targets. Hence, it is sometimes dangerous to extrapolate trial results to real-world practice. High-dose simvastatin alters cholesterol turnover in the brain.2 Low-dose simvastatin has caused significant decreases in positive affect in elderly volunteers.3 Additionally, violent behavior has been associated with hypocholesterolemia resulting from a novel apolipoprotein B gene mutation.4 Furthermore, victims of violent suicides were found to have lower frontal cortex gray-matter cholesterol content than victims of nonviolent suicides.5 Statins were introduced in 1987. During the 1990s, in Scotland, there was a sharp increase in antidepressant prescribing by physicians.6 It is certainly plausible that the increase in the use of antidepressants might have occurred as a result of statin- induced lower cholesterol levels, leading to more depression. As the prescribing of statins becomes more widespread and cholesterol-lowering goals more aggressive, practicing clinicians must be vigilant in recognizing behavior changes, particularly in elderly and depressed individuals. Mark R. Goldstein, M.D. Private Practice, Bonita Springs, Florida Luca Mascitelli, M.D. Medical Service, “Julia” Alpine Brigade, HQ, Udine, Italy Francesca Pezzetta, M.D. Cardiology Department, Hospital of Tolmezzo, Tolmezzo, Italy

Relationship between antidepressant and anxiolytic/hypnotic prescribing: A mixed-methods study

Background: Antidepressant prescribing has dramatically increased in Scotland, and the cause is unknown. Objective: To investigate if the increase in antidepressant prescribing coincided with a reduction in prescribing of anxiolytics and hypnotics; to investigate this relationship at practice level; and to explore whether general practitioners (GPs) explain the increase by their increased use for anxiety. Methods: Study design: analysis of routine prescribing data and interviews with GPs. Setting: Scottish general practices. Participants: 942 practices included in the analysis. Sixty-three GPs in 30 practices completed interviews. Main outcome measures: Quantity of antidepressants, anxiolytics, and hypnotics prescribed. Relationship at practice level between anxiolytic/hypnotic and antidepressant prescribing. Spontaneous comments by GPs about prescribing antidepressants for anxiety. Results: Antidepressant prescribing increased from 28.9 million defined daily doses (DDDs) in 1992/3 to 128.3 million in 2004/5. Anxiolytic/hypnotic prescribing fell from 64.2 million to 55.1 million DDDs. There was a weak, positive correlation between levels of antidepressant and anxiolytic/hypnotic prescribing (+0.084, p=0.010). GPs treated anxiety with antidepressants, although many described an overlap between anxiety and depression. Some spontaneously identified a relationship with benzodiazepine prescribing when asked to explain the increase in antidepressant prescribing. Conclusion: A small part of the increase in antidepressant prescribing is due to substitution for benzodiazepines to treat anxiety.

Depression and Suicidal Behavior

Letters to the EditorDepression and Suicidal BehaviorTamás ZondaTamás ZondaHungarian Association for Suicide PreventionSearch for more papers by this authorPublished Online:January 01, 2005https://doi.org/10.1027/0227-5910.26.1.34PDFView Full Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMore References Apter, A., Bleich, A., King, R.A., Kron, S., Fluch, A., Jotler, M., Cohen, D.J. (1993). Death without warning?. Archives of General Psychiatry, 30, 138–142 First citation in articleCrossref, Google ScholarBronisch, T. (2003). Depression and suicide behavior (Letter to the Editors). Crisis, 24, 179–180 First citation in articleLink, Google ScholarCheng, A.T.A. (1995). Mental illness and suicide. Archives of General Psychiatry, 52, 594–603 First citation in articleCrossref Medline, Google ScholarIsacsson, G. (2000). Suicide prevention - a medical breakthrough?. Acta Psychiatrica Scandinavica, 102, 113–117 First citation in articleCrossref Medline, Google ScholarMarttunen, M.J., Aro, H.M., Henriksson, M.M., Lönnqvist, J.K. (1991). Mental disorder in adolescent suicide. Archives of General Psychiatry, 48, 834–839 First citation in articleCrossref Medline, Google ScholarOravecz, R., Czigler, B., Leskosek, F. (2003). Correlation between suicide rate and antidepressant use in Slovenia. Archives of Suicide Research, 7, 279–285 First citation in articleCrossref, Google ScholarSchrader, E., Meier, B., Brattström, A. (1998). Hypericum treatment of mild-moderate depression in a placebo-controlled study. Human Psychopharmacology, 3, 163–169 First citation in articleCrossref, Google ScholarZonda, T. (2001). A magyarországi öngyilkossági ráták csökkenése mögött feltételezhető okok vázlatos elemzése. [The possible causes beyond the decrease of Hungarian suicide rates] Szenvedélybetegségek, IX(1), 26–30 First citation in articleGoogle ScholarZonda, T., Kăvári, E., Tokody, A. (2000). How to reduce suicide? (A repeated Gotland-study in Hungary). 8th European Congress of Suicide and Suicidal Behavior. Bled, IX, 6–9 First citation in articleGoogle ScholarFiguresReferencesRelatedDetailsCited bySeasonal variation of mortality from external causes in Hungary between 1995 and 20146 June 2019 | PLOS ONE, Vol. 14, No. 6Suicide and mental disorders: A discourse of politics, power, and vested interests23 May 2017 | Death Studies, Vol. 41, No. 8Mental disorder and suicide: A faulty connection19 August 2014 | Australian & New Zealand Journal of Psychiatry, Vol. 49, No. 1Psychological Autopsy Studies as Diagnostic Tools: Are They Methodologically Flawed?Death Studies, Vol. 36, No. 7 Volume 26Issue 1January 2005ISSN: 0227-5910eISSN: 2151-2396 Published online2005 InformationCrisis (2005), 26, pp. 34-35 https://doi.org/10.1027/0227-5910.26.1.34.© 2005Hogrefe & Huber PublishersPDF download

Explaining variation in antidepressant prescribing rates in east London: a cross sectional study

Rates of depression and anxiety in south Asian populations are lower than expected. It remains uncertain whether this reflects a real difference in prevalence or differences in case recognition and management. To examine whether concordance of culture or ethnicity between doctors and patients affects the prescribing rates for antidepressant and anxiolytic medications in general practice populations, taking into account demography, practice size and organization. A cross-sectional general practice study, using practice and demographic data from primary care trusts, doctors' place of qualification from the General Medical Council, combined with practice level prescribing data from the prescription pricing authority (PACT) for the period 2000-2002. Set in 139 practices in the east London primary care trusts (PCTs) of Tower Hamlets, Hackney and Newham, multiethnic areas with large populations of south Asian residents and doctors. The main outcome measure was the annual prescribing rates for each group of drugs, calculated as the mean of two years average daily quantities (ADQs) for each medication, divided by the practice population. In east London the median prescribing rate (ADQs) for all antidepressants was 7.97 (inter-quartile range 4.91-10.76), for all anxiolytics and hypnotics 2.27 (interquartile range 1.11-3.96). There were significant differences in prescribing rates between practices with UK trained GPs and practices with south Asian trained GPs, with the highest rates of antidepressant prescribing in practices with UK trained GPs and low proportions of south Asian patients. No differences were found in anxiolytic and hypnotic prescribing rates between these practices. 57% of the variation in prescribing between practices could be explained by a model including the place of GP qualification, the proportion of registered women, older (>65) patients, and the list size per full time GP. Compared with previous studies prescribing rates for antidepressants have almost doubled over five years, the greatest increase being for selective serotonin re-uptake inhibitors (SSRIs). There is a modest fall in prescribing rates for anxiolytics and hypnotics. Concordance between south Asian practice populations and doctors from similar south Asian cultures is not associated with an increase in antidepressant prescribing. Lower rates of prescribing in practices with south Asian trained doctors occur regardless of the ethnic composition of the practice population. Reasons for these differences are uncertain, but may include differences in explanatory models for presenting symptoms, and management strategies which rely less on a biomedical paradigm.

Association between antidepressant prescribing and suicide in Australia, 1991-2000: trend analysis

Objective: To examine the association between trends in antidepressant prescribing and suicide rates in Australia for 1991-2000.Design: Analysis of databases of suicide and rates of antidepressant prescribing according to age...