What factors influence long-term antidepressant use in primary care? Findings from the Australian diamond cohort study

Background: Antidepressants are one of the most commonly prescribed drugs in primary care. The rise in use is mostly due to an increasing number of long-term users of antidepressants (LTV AD). Little is known about the factors driving increased long-term use. We examined the socio-demographic, clinical factors and health service use characteristics associated with [TV AD to extend our understanding of the factors that may be driving the increase in antidepressant use. Methods: Cross-sectional analysis of 789 participants with probable depression (CES-D >= 16) recruited from 30 randomly selected Australian general practices to take part in a ten-year cohort study about depression were surveyed about their antidepressant use. Results: 165(210%) participants reported < 2 years of antidepressant use and 145(18,4%) reported >= 2 years of antidepressant use. After adjusting for depression severity, [LTV AD was associated with: single (OR 1.56, 95%Cl 1.05-2.32) or recurrent episode of depression (344.2,06-5,74); using SSRIs (3.85, 2.03-7.33), sedatives (2.04, 129-3.22), or antipsychotics (4.51, 1.67-12.17); functional limitations due to long-term illness (2.81, 1.55-5.08), poor/fair self-rated health (1.57, 1.14-2.15), inability to work (2.49, 1.37-4.53), benefits as main source of income (2.15, 133-349), GP visits longer than 20 min (1.79, 1.17-2.73); rating GP visits as moderately to extremely helpful (2.71, 1.79-4.11), and more self-help practices (1.16, 1.09-1.23). Limitations: All measures were self-report. Sample may not be representative of culturally different or adolescent populations. Cross-sectional design raises possibility of confounding by indication. Conclusions: Long-term antidepressant use is relatively common in primary care It occurs within the context of complex mental, physical and social morbidities. Whilst most long-term use is associated with a history of recurrent depression there remains a significant opportunity for treatment re-evaluation and timely discontinuation. (C) 2015 Elsevier B.V. All rights reserved.