Restarting antidepressant treatment following early discontinuation-a primary care database study

Background. Many patients in primary care stop antidepressant treatment after only one prescription, so do not benefit from treatment. Some patients who stop initial antidepressant treatment go on to restart it, but neither the incidence of restarting nor the probability that patients who restart treatment subsequently complete an adequate course of treatment is known. Objective. To examine subsequent antidepressant use in patients who discontinued treatment after only one antidepressant prescription. Methods. We used a primary care database (over 1.2 million records) to study patients who commenced treatment with an eligible antidepressant between April 2007 and March 2008 and who stopped treatment for at least 1 month after the first prescription. We examined their subsequent antidepressant prescriptions to estimate the probability of restarting antidepressant treatment, the likelihood of continuing subsequent treatment and the patient characteristics associated with these. Results. Out of 24 817 patients, 6952 (28%) patients discontinued antidepressant treatment after the first prescription. The cumulative probability of restarting treatment after early discontinuation was 8.6% (95% confidence interval [CI] 8.0-9.3) after 1 month off-treatment, and 24.1% (22.9-25.2) after 9 months off-treatment. The probability of those who restarted treatment continuing for 6 months or more was 29.3% (26.5-32.5). Conclusions. Few patients who stop antidepressant treatment after the first prescription subsequently complete an adequate treatment course within the next year. Initiatives to promote adherence to appropriate antidepressant treatment should begin during the first prescription.