title: Cohort of one million patients initiating antidepressant treatment in France: 12-month follow-up.
abstract: OBJECTIVE
  Previous studies have shown that the recommended minimum 6-month period for antidepressant treatment is actually observed for only a minority of patients. The objectives of this study were to characterise patients with newly prescribed antidepressant treatment in France and identify factors possibly associated with insufficient duration of treatment or the occurrence of certain events such as sick leave, hospitalisations and suicide attempts.
  
  
  METHODS
  Data were extracted from the French health insurance database (SNIIRAM) and the national hospitalisation database (PMSI) for patients covered by the main French health insurance scheme representing 75% of the French population. Patients were included if they had a newly prescribed antidepressant in 2011, but no prior psychiatric diagnosis identified in the databases and no significant psychiatric medication (such as antipsychotic or mood stabiliser) in 2009-2010.
  
  
  RESULTS
  A total of 998 710 patients (2% of the overall population), with a mean age of 50 years and 66% of females, initiated an antidepressant in 2011, which was prescribed by a general practitioner in 89% of cases. Five generic names, including three selective serotonin reuptake inhibitors, accounted for 75% of first prescriptions. Only one reimbursement was observed for 40% of patients. Treatment duration was less than 6 months for more than 80% of patients, more frequently for low income earners, and varied according to age, gender and region. The median time lag between first visit and antidepressant initiation was 27 days. Hospitalisation related to a psychiatric disease over the following 12 months was observed for 3% of patients.
  
  
  CONCLUSIONS
  Duration of treatment and follow-up were both insufficient for the majority of French patients initiating antidepressant treatment in 2011, which may reflect poor quality of care for people with mood or anxiety disorders, possibly because of overdiagnosis and inappropriate drug treatment, or poor adherence and side effects, or poor follow-up.
authors.affiliation: Strategy and Research Department, Caisse nationale de l'assurance maladie, Paris, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Fagot
authors.affiliation: Strategy and Research Department, Caisse nationale de l'assurance maladie, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Cuerq
authors.affiliation: Strategy and Research Department, Caisse nationale de l'assurance maladie, Paris, France.
authors.forename: Solène
authors.initials: S
authors.lastname: Samson
authors.affiliation: Strategy and Research Department, Caisse nationale de l'assurance maladie, Paris, France. anne.fagot-campagna@cnamts.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Fagot-Campagna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D058006:General Practice / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011570:Psychiatry / Q000706:statistics & numerical data; D018582:Sick Leave / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents