Quality, Safety and Informatics Research Group, University of Dundee, Scotland.
Br J Gen Pract. 2011 Sep;61(590):e565-72. doi: 10.3399/bjgp11X593848.
Antidepressant prescribing is increasing worldwide, prompting policy interventions and targets to halt the rise.
To examine time trends in GP antidepressant prescribing using patient-level data.
Longitudinal population database of all community pharmacy dispensed prescriptions for all 325,000 residents of the Tayside region of Scotland.
In each of 3 study years (1995/1996, 2000/2001 and 2006/2007), the volume of antidepressants prescribed was calculated, and numbers of patients prescribed antidepressants in each year, mean treatment duration, and mean dose per patient in that year examined using descriptive statistics.
Total drug volume increased threefold between 1995/1996 and 2006/2007, largely driven by increases in selective serotonin reuptake inhibitor (SSRI) prescribing, and laterally also in 'other' antidepressant prescribing. Tricyclic prescribing is static, but low-dose amitriptyline increasingly dominates this drug class. Increased drug volume was initially driven by increasing patient numbers (from 8.0% of the population prescribed at least once in 1995/1996 to 11.9% in 2000/2001) and increased treatment duration (from 170 days in the measurement year to 200). Latterly, drug volume increases are increasingly attributable to longer duration of treatment and higher mean daily dose.
The large rise in antidepressant volumes is caused by a complex mixture of more patients being prescribed SSRI and 'other' antidepressants, the use of higher doses, and longer durations of treatment, with the balance changing overtime. Tricyclic prescribing is now largely low dose, and probably for conditions other than depression. Interventions to improve the quality of antidepressant prescribing need to be more subtle than blanket targets to reduce the total volume of antidepressants prescribed.
抗抑郁药的处方在全球范围内不断增加，促使政策干预和目标出台以阻止这一增长。
使用患者水平数据来研究全科医生开具抗抑郁药的时间趋势。
苏格兰泰赛德地区所有社区药房配药的所有 325000 名居民的纵向人群数据库。
在 3 个研究年度（1995/1996 年、2000/2001 年和 2006/2007 年）中，计算了每个年度开具的抗抑郁药数量，以及每个年度开具抗抑郁药的患者数量、平均治疗持续时间和当年每位患者的平均剂量，并使用描述性统计进行了检查。
1995/1996 年至 2006/2007 年，总药物量增加了两倍，主要是由于选择性 5-羟色胺再摄取抑制剂（SSRI）处方的增加，以及后来“其他”抗抑郁药处方的增加。三环类药物的处方量保持稳定，但低剂量阿米替林在该药物类别中占主导地位。药物量的增加最初是由患者数量的增加（从 1995/1996 年的 8.0%至少有一次处方到 2000/2001 年的 11.9%）和治疗持续时间的增加（从测量年度的 170 天增加到 200 天）推动的。最近，药物量的增加越来越归因于治疗时间的延长和平均每日剂量的增加。
抗抑郁药数量的大幅增加是由于越来越多的患者被处方 SSRI 和“其他”抗抑郁药、使用更高剂量和更长的治疗时间的复杂混合造成的，而且这种平衡随着时间的推移而变化。三环类药物的处方现在主要是低剂量的，可能用于除抑郁以外的其他疾病。改善抗抑郁药处方质量的干预措施需要比减少开具的抗抑郁药总量的总体目标更加微妙。
