Tiffin Paul A, Mediavilla Jose L, Close Helen, Kasim Adetayo S, Welsh Patrick, Paton Lewis W, Mason James M
Department of Health Sciences, University of York, York, UK.
Health Professions Education Unit, Hull York Medical School, York, UK.
BMJ Open. 2019 Aug 7;9(8):e028201. doi: 10.1136/bmjopen-2018-028201.
To assess the impact of both the Committee on Safety of Medicines (CSM) warning (December 2003) and the National Institute for Health and Care Excellence (NICE) guidance (September 2005) on antidepressant prescription rates in children and adolescents within the UK primary care service.
Population based study of primary care antidepressant prescribing using the Clinical Practice Research Datalink (CPRD).
Under-18s presenting to primary care with a depressive disorder or related diagnostic code recorded in the CPRD.
Antidepressant prescription rates per month per 100 000 depressed 4-17 year olds.
Following the CSM warning, the prior trend towards increased prescribing rates for selective serotonin reuptake inhibitors (SSRIs) in children was significantly reversed (β for change in trend -12.34 (95% CI -18.67 to -6.00, p<0.001)). However, after the publication of the NICE guidelines the prior trend towards increased prescribing resumed for those SSRIs mentioned as potential treatments in the guidance (fluoxetine, citalopram and sertraline) (β for change in trend 11.52 (95% CI 5.32 to 17.73, p<0.001)). Prescribing of other SSRIs and tricyclics remained low.
Despite a strong emphasis on psychosocial interventions for child and adolescent depression, it may be that the NICE guidelines inadvertently encouraged further antidepressant prescribing, at least for those SSRIs cited. Although the guidelines gave cautions and caveats for the use of antidepressants, practitioners may have interpreted these recommendations as endorsing their use in young people with depression and related conditions. However, more accurate prevalence trend estimates for depression in this age group, and information on the use of psychosocial interventions would be needed to rule out other reasons underlying this increase in prescribing.
评估药品安全委员会（CSM）警告（2003年12月）和英国国家卫生与临床优化研究所（NICE）指南（2005年9月）对英国初级医疗服务中儿童及青少年抗抑郁药处方率的影响。
基于人群的初级医疗抗抑郁药处方研究，使用临床实践研究数据链（CPRD）。
18岁以下因抑郁症或CPRD中记录的相关诊断编码就诊于初级医疗的患者。
每100,000名4 - 17岁抑郁症患者每月的抗抑郁药处方率。
CSM发出警告后，此前儿童选择性5-羟色胺再摄取抑制剂（SSRI）处方率上升的趋势显著逆转（趋势变化的β值为-12.34，95%置信区间为-18.67至-6.00，p<0.001）。然而，NICE指南发布后，指南中提及的可能治疗药物（氟西汀、西酞普兰和舍曲林）的SSRI处方率此前上升的趋势又恢复了（趋势变化的β值为11.52，95%置信区间为5.32至17.73，p<0.001）。其他SSRI和三环类药物的处方率仍然很低。
尽管强烈强调对儿童和青少年抑郁症进行心理社会干预，但NICE指南可能无意中鼓励了更多抗抑郁药的处方，至少对于所提及的那些SSRI是如此。尽管指南对抗抑郁药的使用给出了警示和注意事项，但从业者可能将这些建议理解为认可在患有抑郁症及相关病症的年轻人中使用抗抑郁药。然而，需要该年龄组抑郁症更准确的患病率趋势估计以及心理社会干预使用情况的信息，以排除处方增加背后的其他原因。
