Journal
JOURNAL OF PSYCHOPHARMACOLOGY
Volume 31, Issue 5, Pages 553-560Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/0269881117693748
Keywords
CPRD; antidepressants; general practice; switching; primary care; depression
Funding
- Medicines and Healthcare products Regulatory Agency (MHRA) [33437]
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC-West) at Universities Hospitals Bristol National Health Service (NHS) Foundation Trust
- National Institute for Health Research
- Academy of Medical Sciences (AMS) [AMS-SGCL12-Thomas] Funding Source: researchfish
- National Institute for Health Research [CL-2013-25-003] Funding Source: researchfish
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Objective: Non-response to antidepressant treatment is a substantial problem in primary care, and many patients with depression require additional second-line treatments. This study aimed to examine the prevalence and patterns of antidepressant switching in the UK, and identify associated demographic and clinical factors. Method: Cohort analysis of antidepressant prescribing data from the Clinical Practice Research Datalink, a large, anonymised UK primary care database. The sample included 262,844 patients who initiated antidepressant therapy between 1 January 2005 and 31 June 2011. Results: 9.3% of patients switched to a different antidepressant product, with most switches (60%) occurring within 8 weeks of the index date. The proportion switching was similar for selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and other antidepressants (9.3%, 9.8% and 9.2%, respectively). Most switches were to an SSRI (64.5%), and this was the preferred option regardless of initial antidepressant class. Factors predictive of switching included male gender, age, and history of self-harm and psychiatric illness. Conclusion: Over one in every 11 patients who initiates antidepressant therapy will switch medication, suggesting that initial antidepressant treatment has been unsatisfactory. Evidence to guide choice of second-line treatment for individual patients is currently limited. Additional research comparing different pharmacological and psychological second-line treatment strategies is required in order to inform guidelines and improve patient outcomes.
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