Antidepressant prescriptions and therapy intensification in men and women newly diagnosed with depression in the UK.

BACKGROUND

Evidence on therapeutic interventions and factors driving treatment intensification (TI) in people with incident depression in UK are scarce.

AIMS

To explore antidepressant prescribing patterns and factors influencing TI.

DESIGN

and setting: Retrospective cohort study of adults with incident depression diagnosed between 2006 and 2017 using UK primary care database.

METHODS

Patterns of antidepressant prescriptions, and factors influencing TI were evaluated by sex.

RESULTS

In 931,302 people with depression (90% initiating antidepressants), mean age was 39 years, 41% were male, 14% had cardiometabolic multimorbidity (CMM), and 54% were diagnosed at < 40 years. Being the most prescribed first-line antidepressant (62%), SSRI prescribing rate increased from 66 per 1000 person-years to 170 per 1000 person-years; 24% (2% dose escalation, 4% adding, 18% switching) of first-line antidepressant initiators intensified with 13 months median time to TI. Compared to 60-70 years, younger adults had significantly higher TI risk (range of hazards ratio, HR: 1.08-1.42). CMM and anxiety were associated with 15-24% and 39-49% significantly higher TI risks respectively. First-line antidepressant and deprivation status influenced TI differently by gender.

CONCLUSIONS

Men and women with depression in UK have different antidepressant prescription patterns in real-world. Age at diagnosis, deprivation status and cardiometabolic multimorbidity are the major sociodemographic and non-psychiatric risk factors for therapeutic changes.