title: Relationship between antidepressant and anxiolytic/hypnotic prescribing: a mixed-methods study.
abstract: 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.
authors.affiliation: Section of General Practice, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow, UK. j.morrison@clinmed.gla.ac.uk
authors.forename: Jill
authors.initials: J
authors.lastname: Morrison
authors.forename: Mary-Jane
authors.initials: MJ
authors.lastname: Anderson
authors.forename: Sara
authors.initials: S
authors.lastname: Mac Donald
authors.forename: Margaret
authors.initials: M
authors.lastname: Maxwell
authors.forename: Rosalia
authors.initials: R
authors.lastname: Munoz-Arroyo
authors.forename: Andrew
authors.initials: A
authors.lastname: Power
authors.forename: Michael
authors.initials: M
authors.lastname: Smith
authors.forename: Matthew
authors.initials: M
authors.lastname: Sutton
authors.forename: Philip
authors.initials: P
authors.lastname: Wilson
mesh_terms: 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
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines