title: Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose.
abstract: The Dutch guideline for the treatment of depression in young people recommends initiating antidepressant treatment with fluoxetine, as the evidence for its efficacy is strongest and the risk of suicidality may be lower than with other antidepressants. Furthermore, low starting doses are recommended. We aimed to determine whether antidepressant prescriptions are in accord with guidelines. A cohort of young people aged between 6 and 17 at the time of antidepressant initiation was selected from IABD, a Dutch pharmacy prescription database. The percentage of prescriptions for each antidepressant was determined. Starting and maintenance doses were determined and compared with recommendations for citalopram, fluoxetine, fluvoxamine, and sertraline. During the study period, 2942 patients initiated antidepressant treatment. The proportion of these young people who were prescribed fluoxetine increased from 10.1 % in 1994-2003 to 19.7 % in 2010-2014. However, the most commonly prescribed antidepressants were paroxetine in 1994-2003 and citalopram in 2004-2014. The median starting and maintenance doses were ≤0.5 DDD/day for tricyclic antidepressants and 0.5-1 DDD/day for SSRIs and other antidepressants. Starting doses were guideline-concordant 58 % of the time for children, 31 % for preteens, and 16 % for teens. Sixty percent of teens were prescribed an adult starting dose. In conclusion, guideline adherence was poor. Physicians preferred citalopram over fluoxetine, in contrast to the recommendations. Furthermore, although children were prescribed a low starting dose relatively frequently, teens were often prescribed an adult starting dose. These results suggest that dedicated effort may be necessary to improve guideline adherence.
authors.affiliation: Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. y.a.de.vries@umcg.nl.
authors.forename: Ymkje Anna
authors.identifier: http://orcid.org/0000-0003-4580-4873
authors.initials: YA
authors.lastname: de Vries
authors.affiliation: Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
authors.affiliation: Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Luuk
authors.initials: L
authors.lastname: Kalverdijk
authors.affiliation: Unit PharmacoEpidemiology and PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
authors.forename: Jens H J
authors.initials: JH
authors.lastname: Bos
authors.affiliation: Unit PharmacoEpidemiology and PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
authors.forename: Catharina C M
authors.initials: CC
authors.lastname: Schuiling-Veninga
authors.affiliation: Unit PharmacoEpidemiology and PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
authors.forename: Eelko
authors.initials: E
authors.lastname: Hak
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000008:administration & dosage*; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage*; D002648:Child; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009426:Netherlands; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage*
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Antidepressants; Children and adolescents; Dosing; Guidelines; Prescription trends