Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands.
Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
BMJ Open. 2019 Feb 5;9(2):e024051. doi: 10.1136/bmjopen-2018-024051.
Antidepressant prescribing almost doubled in the Netherlands between 1996 and 2012, which could be accounted for by longer continuation after the first prescription. This might be problematic given a growing concern of large-scale antidepressant dependence. We aimed to assess the extent and determinants of chronic antidepressant prescribing among patient aged 18 years and older. We hypothesise a relatively large prevalence of chronic (>2 years) prescription.
A longitudinal observational study based on routinely registered prescription data from general practice.
189 general practices in the Netherlands.
326 025 patients with valid prescription data for all 5 years of the study.
Primary outcome measure: the number of patients (N) receiving at least four antidepressant prescriptions in 2011, as well as during each of the four subsequent years. Secondary outcome measure: the above, but specified for selective serotonin reuptake inhibitors and for tricyclic antidepressants.
Antidepressants were prescribed to almost 7% of our 326 025 participants each year. They were prescribed for depression (38%), anxiety (17%), other psychological disorders (20%) and non-psychological indications (25%). Antidepressants were prescribed in all 5 years to the 42% of the population who had at least four prescriptions dispensed in 2011. Chronic prescribing was higher among women than men, for those aged 45-64 years than for those aged >65 years and for those treated for depression or anxiety than for non-psychological indications (eg, neuropathic pain). Chronic prescribing also varied markedly among general practices.
Chronic antidepressant use is common for depression and for anxiety and non-psychological diagnoses. Once antidepressants have been prescribed, general practitioners and other prescribers should be aware of the risks associated with long-term use and should provide annual monitoring of the continued need for therapy.
1996 年至 2012 年期间，荷兰的抗抑郁药处方量几乎翻了一番，这可能是由于首次处方后继续治疗的时间更长所致。鉴于人们对大规模抗抑郁药依赖的担忧日益增加，这可能会引发问题。我们旨在评估 18 岁及以上患者中慢性抗抑郁药处方的程度和决定因素。我们假设慢性（> 2 年）处方的患病率相对较高。
一项基于一般实践中常规登记处方数据的纵向观察性研究。
荷兰 189 家普通诊所。
326025 名有研究期间所有 5 年有效处方数据的患者。
主要结局测量：2011 年至少接受 4 次抗抑郁药处方的患者人数（N），以及随后 4 年中的每一年。次要结局测量：上述内容，但具体针对选择性 5-羟色胺再摄取抑制剂和三环抗抑郁药。
几乎每年有近 7%的 326025 名参与者被开出抗抑郁药。它们被开给抑郁症（38%）、焦虑症（17%）、其他心理障碍（20%）和非心理指征（25%）患者。在 2011 年至少开出 4 剂处方的人群中，有 42%的人在所有 5 年都开出了抗抑郁药。与男性相比，女性的慢性处方比例更高，与>65 岁人群相比，45-64 岁人群的慢性处方比例更高，与非心理指征（如神经痛）相比，抑郁症或焦虑症患者的慢性处方比例更高。一般实践之间的慢性处方差异也很大。
慢性抗抑郁药的使用在抑郁症和焦虑症以及非心理诊断中很常见。一旦开出抗抑郁药，全科医生和其他开处方者就应该意识到长期使用相关的风险，并应每年监测继续治疗的需求。
