Antidepressant Rates Research Articles

Association between a publicly funded universal drug program and antipsychotic and antidepressant medication dispensing to children

BackgroundThe prescribing of antidepressants and antipsychotics to children has increased worldwide, but little is known about how changes in drug funding policy influence the practice. In 2018, Ontario introduced a universal pharmacare program (OHIP+) for children and youth, amending it in April 2019 to cover only those without private insurance. We examined the association of these policy changes with antipsychotic and antidepressant medication prescribing.MethodsWe conducted a population-based study of antidepressant and antipsychotic medication dispensing to children ≤ 18 years old between September 1, 2014, and February 29, 2020. We obtained dispensing data from the IQVIA Geographic Prescription Monitor database, and used interventional autoregressive integrated moving average models to examine whether the implementation of OHIP + and its subsequent revision were associated with changes in dispensing.ResultsThe implementation of OHIP + was not associated with changes in the rate of antidepressants (-19.3 units per 1,000 population; 95% confidence interval [CI]: -41.7 to 3.1) or antipsychotics (+ 1.0 unit per 1,000 population; 95% CI: -5.4 to 7.5) dispensed. Similarly, subsequent changes to the program restricting coverage to children without private insurance were not associated with antidepressant (0.3 units per 1,000; 95% CI: -7.4 to 7.9) or antipsychotic (1.0 units per 1,000; 95% CI: -0.9 to 2.9) dispensing trends.ConclusionImplementation of a publicly-funded pharmacare program did not influence trends in antidepressant or antipsychotic medication dispensing among children.

Antidepressant prescribing in Irish children: secular trends and international comparison in the context of a safety warning.

BackgroundIn 2003, the Irish Medicines Board (IMB) warned against the treatment of childhood depression with selective serotonin reuptake inhibitors (SSRIs) due to increased risk of suicide. This study examined the effect of this warning on the prevalence of anti-depressants in Irish children and compared age and gender trends and international comparisons of prescription rates.MethodsA retrospective cohort study of the Irish Health Service Executive (HSE) pharmacy claims database for the General Medical Services (GMS) scheme for dispensed medication. Data were obtained for 2002–2011 for those aged ≤15 years. Prevalence of anti-depressants per 1000 eligible population, along with 95 % confidence intervals, were calculated. A negative binomial regression analysis was used to investigate trends and compare rates across years, sex and age groups (0–4, 5–11, 12–15 years). International prescribing data were retrieved from the literature.ResultsThe prevalence of anti-depressants decreased from 4.74/1000 population (95 % CI: 4.47-5.01) in 2002 to 2.61/1000 population (95 % CI: 2.43-2.80) in 2008. SSRI rates decreased from 2002 to 2008. Prescription rates for contra-indicated SSRIs paroxetine, sertraline and citralopram decreased significantly from 2002 to 2005, and, apart from paroxetine, only small fluctuations were seen from 2005 onwards. Fluoxetine was the most frequently prescribed anti-depressant and rates increased between 2002 and 2011. Anti-depressant rates were higher for younger boys and older girls. The Irish prevalence was lower than the US, similar to the U.K. and higher than Germany and Denmark.ConclusionsThe direction and timing of these trends suggest that medical practitioners followed the IMB advice.

EPA-0429 – Psychotropic prescribing patterns in english prisons: a cross-sectional study

Introduction Psychotropic medicines are widely used to treat mental illness in the community. In prisons, however, the equity, continuity and appropriateness of prescribing for mentally ill prisoners have been questioned. Currently, there are no robust data regarding prescribing patterns in English prisons; yet these are essential to managing the overall clinical, cost effective, and safe use of medicines. Aim We aimed to investigate patterns of psychotropic medication prescribing in English prisons. Objectives • To establish psychotropic prescribing rates in prisons. • To compare prison psychotropic prescribing patterns with the wider community. • To gain insight into staff and patient perspectives on psychotropic prescribing in prisons. Methods We conducted a cross-sectional survey of 12 prisons to generate prescribing rates for antidepressants, antipsychotics, hypnotic/anxiolytics and/or central nervous system stimulants (chapters 4.1–4.4 of the British National Formulary). On census days, we used clinical records to collect demographic, clinical and prescription data on all patients in receipt of psychotropic medication. Equivalent data on community-based patients were supplied by the UK General Practice Research Database for comparison purposes. Qualitative interviews were completed with 16 members of staff and 17 patients and analysed thematically. Results and Conclusions This presentation will describe the rates, types and doses of medicines prescribed in prisons to treat mental illness. Appropriate community comparisons will be made, accounting for demographic and clinical characteristics. Staff and patient perspectives will be explored. Implications for patient safety, equivalence and appropriateness of prescribing will be discussed.

Association between Antidepressant Prescribing and Suicide Rates in OECD Countries: An Ecological Study

We have conducted an ecological study to assess the association between antidepressant prescribing and suicide rates using the Organisation for Economic Co-operation and Development (OECD) health data, making this the largest ecological study in recent times. Data were derived for the years 1995-2008 from the OECD health data set. The residuals for all variables were adjusted for country and year within each country. These were then analysed to identify predictors of suicide rate. Pearson's rank correlation coefficient and linear regression model were employed to assess associations and identify significant predictors of suicide rate. Suicide rate has significant positive correlations with antidepressant rates (p=0.031) and unemployment (p=0.028). It also has a significant negative correlation with inpatient psychiatric beds (p=0.039). The actual coefficients are less than ±0.16, indicating weak relationships. After adjusting for other variables, the only variable that is a statistically significant predictor of suicide rate is antidepressant prescribing (p=0.005, r²=0.09). Our analysis using this large data set suggests a statistically significant, albeit weak positive, association between antidepressant prescribing and suicide rates.

Prospective Observation of Switching Rate of Antidepressants in Management of Depressive Episode in 3 Months

Objective: to observe prospectively of switching rate of antidepressants in management of depressive episode. Methods: 190 patients with depressive episode treated by antidepressants were observed for 3 months and switching rate were assessed under “best natural therapy”. And switching criteria was following: 1) manic or hypomanic episode; or 2) promoting rapid cycling; or 3) YMRS ≥ 11 or irritability or aggravation in YMRS ≥ 3. 4) Psychiatrist thinks that the patients should be stopped to take antidepressants and should be placed by mood stabilizer or antipsychotics or their combination. Results: 1) 18 of 190 patients was found to switch in 3 month therapy. The switching rate was 9.47%. 2) 4 of 61 males was found and 14 females was found to switch, their switching rate was not significant (6.56%, 10.85%, X2 = 0.89, P > 0.05). 3) 10 of 170 unipolar depression and 8 of bipolar depression was found to switch, their switching rate was very significant (5.88%, 40%, X2 = 24.29, P 2 = 1.47, P > 0.05). 5) 7 of 54 patients token more two antidepressants and 11 patients token single antidepressant was found to switch, their switching rate was not significant (12.96%, 8.08%, X2 = 1.07, P > 0.05). 6) 7 of 38 patients with family history of mood disorder and 11 of patients without family history of mood disorder was found to switch, their switching rate was significant (18.4%, 7.23%, X2 = 4.43, P

Misdiagnosed Patients With Bipolar Disorder

The purpose of this study was to examine comorbidities, treatment patterns, and direct treatment costs of patients with bipolar disorder who are misdiagnosed with unipolar depression. This study is a retrospective analysis of data from the MarketScan Commercial Claims and Encounters (CCE) database. Logistic regressions and analyses of variance were used to compare the misdiagnosis cohort to 3 age- and gender-matched comparison cohorts (recognized bipolar, depression, and no psychiatric disorders based on ICD-9-CM criteria) during the year 2000. Each cohort had 769 individuals (68.0% female; mean age of roughly 42 years). The misdiagnosis cohort had higher rates of several psychiatric comorbidities than the depression cohort (e.g., personality disorders, alcohol abuse, psychotic disorder) and the bipolar cohort (e.g., generalized anxiety disorder, panic) but a lower rate of psychotic disorders than the bipolar cohort (p < .05). Compared with the bipolar cohort, the misdiagnosis cohort was more likely to receive antidepressants, but less likely to receive anticonvulsants, antipsychotics, or lithium (all p < .001). Antidepressant rates were similar among the misdiagnosis and depression cohorts. Group differences were found in mean annual costs for anticonvulsants, antipsychotics, lithium, antidepressants, and total treatment costs: bipolar (USD $442, $310, $67, $497, $8600); misdiagnosis (USD $221, $185, $20, $704, $8761); depression (USD $70, $74, $5, $657, $7288). Misdiagnosed bipolar patients received inappropriate and costly treatment regimens involving overuse of antidepressants and underuse of potentially effective medications. Patterns of psychiatric comorbidity suggest one possible strategy for improving recognition of bipolar disorder among patients presenting with depressive symptoms. Patients who present with the observed pattern of comorbidities may benefit from additional screening for bipolar disorder. It is recommended that steps be taken to minimize misdiagnosis in clinical settings.