Early discontinuation of antidepressants in general practice: association with patient and prescriber characteristics.
BACKGROUND
Most antidepressant treatment is initiated and continued in general practice but, despite current guidelines, treatment duration is often short among patients with depression. Discontinuation may, however, be caused by a complexity of factors, but so far research has focused on drug effects, adverse effects and drug regimens.


OBJECTIVE
Our aim was to analyse whether early discontinuation of first-time antidepressant treatment in general practice may be predicted by (i) social position and psychiatric history of the patient; and (ii) demography, practice activity and the general prescribing behaviour of the GP.


METHODS
Early discontinuation, i.e. that patients do not purchase antidepressants in the 6 months following first prescription, was analysed using established databases. Among patients presenting in 174 general practices in Funen County, Denmark, 4860 adult first-time users of antidepressants were identified (regardless of diagnosis). The inclusion period was January 1998-June 1999.


RESULTS
One in three patients did not purchase antidepressants in the 6 months following first prescription, but rates were higher among those prescribed tricyclic compared with new generation antidepressants. Patients' age and sex did not have an influence, but early discontinuation was more frequent among patients of low socio-economic status and patients prescribed in practices characterized by high prescribing rates. No association with psychiatric history was observed.


CONCLUSIONS
Early discontinuation is frequent in general practice, and patients of low social status are at greater risk. Adherence-promoting strategies should pay attention to the high prescribing doctors. Further studies may answer the question of whether the association between doctors' prescribing behaviour and early discontinuation is a feature specific to antidepressants or a more general phenomenon.
Hansen
Dorte Gilså
DG
Research Unit of General Practice, University of Southern Denmark, Odense, Denmark. DGilsaa@health.sdu.dk
Vach
Werner
W
Rosholm
Jens-Ulrik
JU
Søndergaard
Jens
J
Gram
Lars F
LF
Kragstrup
Jakob
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000145:classification / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D003718:Denmark; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D012959:Socioeconomic Factors
D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic