title: Restarting antidepressant treatment following early discontinuation--a primary care database study.
abstract: BACKGROUND
  Many patients in primary care stop antidepressant treatment after only one prescription, so do not benefit from treatment. Some patients who stop initial antidepressant treatment go on to restart it, but neither the incidence of restarting nor the probability that patients who restart treatment subsequently complete an adequate course of treatment is known.
  
  
  OBJECTIVE
  To examine subsequent antidepressant use in patients who discontinued treatment after only one antidepressant prescription.
  
  
  METHODS
  We used a primary care database (over 1.2 million records) to study patients who commenced treatment with an eligible antidepressant between April 2007 and March 2008 and who stopped treatment for at least 1 month after the first prescription. We examined their subsequent antidepressant prescriptions to estimate the probability of restarting antidepressant treatment, the likelihood of continuing subsequent treatment and the patient characteristics associated with these.
  
  
  RESULTS
  Out of 24817 patients, 6952 (28%) patients discontinued antidepressant treatment after the first prescription. The cumulative probability of restarting treatment after early discontinuation was 8.6% (95% confidence interval [CI] 8.0-9.3) after 1 month off-treatment, and 24.1% (22.9-25.2) after 9 months off-treatment. The probability of those who restarted treatment continuing for 6 months or more was 29.3% (26.5-32.5).
  
  
  CONCLUSIONS
  Few patients who stop antidepressant treatment after the first prescription subsequently complete an adequate treatment course within the next year. Initiatives to promote adherence to appropriate antidepressant treatment should begin during the first prescription.
authors.affiliation: Centre of Academic Primary Care, c.burton@abdn.ac.uk.
authors.forename: Christopher
authors.initials: C
authors.lastname: Burton
authors.affiliation: Medical School and.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cochran
authors.affiliation: Department of Psychiatry, University of Aberdeen, Aberdeen, UK.
authors.forename: Isobel M
authors.initials: IM
authors.lastname: Cameron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D003863:Depression / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011336:Probability; D016016:Proportional Hazards Models; D013997:Time Factors; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressant treatment; database research; depression; prescribing; primary care.