title: What factors influence long-term antidepressant use in primary care? Findings from the Australian diamond cohort study.
abstract: 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 (LTU 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 LTU 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 (21.0%) participants reported <2 years of antidepressant use and 145 (18.4%) reported ≥2 years of antidepressant use. After adjusting for depression severity, LTU AD was associated with: single (OR 1.56, 95%CI 1.05-2.32) or recurrent episode of depression (3.44, 2.06-5.74); using SSRIs (3.85, 2.03-7.33), sedatives (2.04, 1.29-3.22), 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, 1.33-3.49), GP visits longer than 20min (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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia; University Institute of Psychotherapy, Department of Psychiatry-CHUV, University of Lausanne, Switzerland. Electronic address: gilles.ambresin@chuv.ch.
authors.forename: Gilles
authors.initials: G
authors.lastname: Ambresin
authors.affiliation: General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia.
authors.forename: Victoria
authors.initials: V
authors.lastname: Palmer
authors.affiliation: General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia.
authors.forename: Konstancja
authors.initials: K
authors.lastname: Densley
authors.affiliation: Primary Medical Care, University of Liverpool. Liverpool, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Dowrick
authors.affiliation: National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Gail
authors.initials: G
authors.lastname: Gilchrist
authors.affiliation: General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Gunn
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001315:Australia; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D057566:Self Report; D012959:Socioeconomic Factors; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressive agents; Depression; Depressive disorder; Treatment outcome