Explaining the variation between practices in the duration of new antidepressant treatment: a database cohort study in primary care

Average duration of treatment with antidepressants among concession card holders in Australia

“…The number of patients in our study who redeemed only one prescription during the period from 2010–2012 was less than 10%. This is in line with American findings (Pratt et al, 2011), but less than in other studies (Burton et al, 2012, 2015; Kjosavik et al, 2011; Milea et al, 2010; Serna et al, 2010; Verdoux et al, 2011). It is well known that GPs prescribe the vast majority of antidepressants (Australian Institute of Health and Welfare, 2014; Kjosavik et al, 2009, 2011; McManus et al, 2003).…”

“…Guidelines for treatment of major depression recommend maintaining antidepressant drug use for 6 to 12 months after remission of the first episode, and for 1 to 5 years for patients who have relapsed (Hegarty et al, 2009;Lam et al, 2009;Timonen and Liukkonen, 2008). Despite the recommendations, studies have shown that the treatment with antidepressants in primary care has been discontinued early in a high proportion among new users (Burton et al, 2012(Burton et al, , 2015Milea et al, 2010;Serna et al, 2010). On the other hand, the risk of re-initiation of antidepressants in patients with short treatment duration has been shown to be lower than in patients with a first-time treatment duration of more than 6 months, perhaps due to over-prescribing of antidepressants to patients without a real need for such a treatment (Verdoux et al, 2011).…”

“…Increased use of antidepressants may result from elongation of treatment episodes as recommended by guidelines (Reid et al, 2014), but may also be a result of too lengthy a treatment if the physician does not cease the treatment when recommended (Johnson et al, 2012). Studies about treatment duration have typically focussed on treatment in new user populations (Burton et al, 2012(Burton et al, , 2015Serna et al, 2010), but knowledge about overall antidepressant treatment duration is scarce.…”

What proportion of initially prescribed antidepressants is still being prescribed chronically after 5 years in general practice? A longitudinal cohort analysis

“…Medication reviews may reflect such a policy, possibly by routine consultations between GP and pharmacist. As proven in other studies, medication reviews may be routine in some practices, leading to reduced long-term antidepressant use, but may be non-existent in other practices, with opposing results 39. New initiatives, such as the introduction of tapering strips40 or the continuous monitoring of patients who discontinue antidepressants, could offer new insights and help develop recommendations for GPs to help patients stop treatment when it is no longer needed.…”

Can we trust studies using audit software? A case study of atrial fibrillation audit

“…The need for consistent coding in diabetes has been highlighted 9 and a recent study of depression management stressed that duration of treatment was associated with the proportion of patients being coded as having depression, 10 underlining the impact of coding on individual patient care.…”