Relationship between antidepressant and anxiolytic/hypnotic prescribing: a mixed-methods study.
BACKGROUND
Antidepressant prescribing has dramatically increased in Scotland, and the cause is unknown.


OBJECTIVE
To investigate if the increase in antidepressant prescribing coincided with a reduction in prescribing of anxiolytics and hypnotics; to investigate this relationship at practice level; and to explore whether general practitioners (GPs) explain the increase by their increased use for anxiety.


METHODS



METHODS
analysis of routine prescribing data and interviews with GPs.


METHODS
Scottish general practices.


METHODS
942 practices included in the analysis. Sixty-three GPs in 30 practices completed interviews.


METHODS
Quantity of antidepressants, anxiolytics, and hypnotics prescribed. Relationship at practice level between anxiolytic/hypnotic and antidepressant prescribing. Spontaneous comments by GPs about prescribing antidepressants for anxiety.


RESULTS
Antidepressant prescribing increased from 28.9 million defined daily doses (DDDs) in 1992/3 to 128.3 million in 2004/5. Anxiolytic/hypnotic prescribing fell from 64.2 million to 55.1 million DDDs. There was a weak, positive correlation between levels of antidepressant and anxiolytic/hypnotic prescribing (+0.084, p=0.010). GPs treated anxiety with antidepressants, although many described an overlap between anxiety and depression. Some spontaneously identified a relationship with benzodiazepine prescribing when asked to explain the increase in antidepressant prescribing.


CONCLUSIONS
A small part of the increase in antidepressant prescribing is due to substitution for benzodiazepines to treat anxiety.
Morrison
Jill
J
Section of General Practice, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow, UK. j.morrison@clinmed.gla.ac.uk
Anderson
Mary-Jane
MJ
Mac Donald
Sara
S
Maxwell
Margaret
M
Munoz-Arroyo
Rosalia
R
Power
Andrew
A
Smith
Michael
M
Sutton
Matthew
M
Wilson
Philip
P
D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use; D003625:Data Collection; D003863:Depression / Q000188:drug therapy; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012606:Scotland
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines