title: Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study.
abstract: BACKGROUND
  Antidepressant prescribing continues to rise. Contributing factors are increased long-term prescribing and possibly the use of higher selective serotonin re-uptake inhibitor (SSRI) doses.
  
  
  OBJECTIVE
  To review general practice patients prescribed the  same antidepressant long-term (≥2 years) and evaluate prescribing and management pre and post-review.
  
  
  METHODS
  Prospective observational cohort study using routine data from 78 urban general practices, Scotland.
  
  
  METHODS
  All patients prescribed  antidepressants (excluding amitriptyline) for ≥2 years were identified from records November 2009 to March 2010. GPs selected patients for face-to-face review of clinical condition and medication, December 2009 to September 2010. Pre- and post-review data were collected; average antidepressant  doses and changes in prescribed daily doses were calculated. Onward referral to support services was recorded.
  
  
  RESULTS
  8.6% (33 312/388 656) of all registered patients were prescribed an antidepressant, 47.1% (15 689) were defined as long-term users and 2849 (18.2%) were  reviewed. 811 (28.5%) patients reviewed had a change in antidepressant therapy: 7.0% stopped, 12.8% reduced dose, 5.3% increased dose, and 3.4% changed antidepressant, resulting in 9.5% (95% CI = 9.1% to 9.8% P<0.001) reduction in prescribed daily dose and 8.1% reduction in prescribing  costs. 6.3% were referred onwards, half to NHS Mental Health Services. Pre-review SSRI doses were 10-30% higher than previously reported.
  
  
  CONCLUSIONS
  Almost half of all people prescribed antidepressants were long-term users. Appropriate reductions in prescribing can  be achieved by reviewing patients. Higher SSRI doses may be contributing to current antidepressant growth.
authors.affiliation: NHS Greater Glasgow & Clyde, Pharmacy & Prescribing Support Unit, Queens Park House, Glasgow. c.johnson2@nhs.net
authors.forename: Chris F
authors.initials: CF
authors.lastname: Johnson
authors.forename: Hector J
authors.initials: HJ
authors.lastname: Macdonald
authors.forename: Pauline
authors.initials: P
authors.lastname: Atkinson
authors.forename: Alasdair I
authors.initials: AI
authors.lastname: Buchanan
authors.forename: Noreen
authors.initials: N
authors.lastname: Downes
authors.forename: Nadine
authors.initials: N
authors.lastname: Dougall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000008:administration & dosage*; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000453:epidemiology; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D058006:General Practice; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D015995:Prevalence; D011320:Primary Health Care; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology; D014505:Urban Population
chemical_list: D000928:Antidepressive Agents