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Anti‐depressants in primary care: analysis of treatment discontinuations
Author(s) -
McGettigan P,
Kelly A,
Carvahlo M,
Feely J
Publication year - 2000
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/1099-1557(200011)9:6<521::aid-pds525>3.0.co;2-k
Subject(s) - discontinuation , medicine , medical prescription , tricyclic , pharmacoepidemiology , depressant , defined daily dose , population , psychiatry , pediatrics , pharmacology , environmental health
It is well known that adherence to anti‐depressant therapy is often poor, but the literature describes little in the way of systematic analyses to determine co‐relation between treatment discontinuation and possible contributing factors. We used a community dispensing database to review anti‐depressant prescribing patterns and continuity of therapy over a period of 10 months among a population of community‐based general practice patients. Some 109,228 anti‐depressant prescriptions were dispensed to 24,073 patients, of whom 37.5% collected a single prescription only. Tricyclic anti‐depressant prescribing declined significantly during the observation period (from 70% of prescriptions in month 1 to 66% in month 10) while that of selective serotonin reuptake inhibitors (SSRIs) increased (23% in month 1, 28% in month 10) ( p < 0.0001). Some 27% of those on tricyclics were prescribed <50% of the defined daily dose (DDD) compared with 2% of those on SSRIs. Among patients new to therapy who collected >1 prescription, adherence was poor and declined over time. The factors that influenced the extent to which patients failed to adhere to therapy included dosage level (% DDD) and age ( p <0.0001 for both), but not drug class or sex. The findings suggest that low dosage is a contributory factor in treatment discontinuation, and that contrary to common perception, SSRIs are not necessarily associated with better adherence to therapy than tricyclics. Copyright © 2000 John Wiley & Sons, Ltd.