NHS Greater Glasgow & Clyde, Pharmacy & Prescribing Support Unit, Queens Park House, Glasgow.
Br J Gen Pract. 2012 Nov;62(604):e773-9. doi: 10.3399/bjgp12X658304.
Antidepressant prescribing continues to rise. Contributing factors are increased long-term prescribing and possibly the use of higher selective serotonin re-uptake inhibitor (SSRI) doses.
To review general practice patients prescribed the same antidepressant long-term (≥2 years) and evaluate prescribing and management pre and post-review.
Prospective observational cohort study using routine data from 78 urban general practices, Scotland.
All patients prescribed antidepressants (excluding amitriptyline) for ≥2 years were identified from records November 2009 to March 2010. GPs selected patients for face-to-face review of clinical condition and medication, December 2009 to September 2010. Pre- and post-review data were collected; average antidepressant doses and changes in prescribed daily doses were calculated. Onward referral to support services was recorded.
8.6% (33 312/388 656) of all registered patients were prescribed an antidepressant, 47.1% (15 689) were defined as long-term users and 2849 (18.2%) were reviewed. 811 (28.5%) patients reviewed had a change in antidepressant therapy: 7.0% stopped, 12.8% reduced dose, 5.3% increased dose, and 3.4% changed antidepressant, resulting in 9.5% (95% CI = 9.1% to 9.8% P<0.001) reduction in prescribed daily dose and 8.1% reduction in prescribing costs. 6.3% were referred onwards, half to NHS Mental Health Services. Pre-review SSRI doses were 10-30% higher than previously reported.
Almost half of all people prescribed antidepressants were long-term users. Appropriate reductions in prescribing can be achieved by reviewing patients. Higher SSRI doses may be contributing to current antidepressant growth.
抗抑郁药的处方量持续上升。促成因素包括长期处方的增加和可能使用更高剂量的选择性 5-羟色胺再摄取抑制剂（SSRIs）。
回顾长期（≥2 年）服用相同抗抑郁药的普通患者，并评估审查前后的处方和管理情况。
使用苏格兰 78 家城市全科诊所的常规数据进行前瞻性观察队列研究。
从 2009 年 11 月至 2010 年 3 月的记录中确定所有服用抗抑郁药（不包括阿米替林）≥2 年的患者。全科医生于 2009 年 12 月至 2010 年 9 月选择患者进行临床状况和药物的面对面审查。收集审查前后的数据；计算平均抗抑郁药剂量和规定日剂量的变化。记录向支持服务的转介情况。
所有注册患者中，8.6%（33312/388656）被处方抗抑郁药，47.1%（15689）被定义为长期使用者，2849 人（18.2%）接受了审查。2849 名接受审查的患者中有 811 名（28.5%）改变了抗抑郁治疗：7.0%停药，12.8%减少剂量，5.3%增加剂量，3.4%改变抗抑郁药，导致规定日剂量减少 9.5%（95%CI=9.1%至 9.8%，P<0.001），处方费用减少 8.1%。6.3%的患者被转介，其中一半转介到 NHS 心理健康服务。审查前 SSRI 剂量比之前报道的高出 10-30%。
几乎一半服用抗抑郁药的人都是长期使用者。通过审查患者，可以适当减少处方。更高剂量的 SSRIs 可能是当前抗抑郁药增长的原因。
