Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study

Journal article

Background Antidepressants are commonly prescribed. There are clear national guidelines in relation to treatment sequencing. This study examines trends and variation in antidepressant prescribing across English primary care. Aim To examine trends and variation in antidepressant prescribing in England, with a focus on: monoamine oxidase inhibitors (MAOIs); paroxetine; and dosulepin and trimipramine. Design & amp; Retrospective longitudinal study using national and practice-level data on antidepressant items prescribed per year (1998–2018) and per month (2010–2019). Method Class- and drug-specific proportions were calculated at national and practice levels. Descriptive statistics were generated, percentile charts and maps were plotted, and logistic regression analysis was conducted. Results Antidepressant prescriptions more than tripled between 1998 and 2018, from 377 items per 1000 population to 1266 per 1000. MAOI prescribing fell substantially, from 0.7% of all antidepressant items in 1998 to 0.1% in 2018. There was marked variation between practices in past year prescribing of paroxetine (median practice proportion [MPP] = 1.7%, interdecile range [IDR] = 2.6%) and dosulepin (MPP = 0.7%, IDR = 1.8%), but less for trimipramine (MPP = 0%, IDR = 0.2%). Conclusion Rapid growth and substantial variation in antidepressant prescribing behaviour was found between practices. The causes could be explored using mixed-methods research. Interventions to reduce prescribing of specific antidepressants, such as dosulepin, could include review prompts, alerts at the time of prescribing, and clinician feedback through tools like OpenPrescribing.net

Authors: Bogowicz, P; Curtis, HJ; Walker, AJ; Cowen, P; Geddes, J

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Royal College of General Practitioners
• Journal: British Journal of General Practice Open
• Volume: 5
• Issue: 4
• Pages: BJGPO.2021.0020-BJGPO.2021.0020
• Publication date: 2021-05-13
• DOI: 10.3399/bjgpo.2021.0020
• EISSN: 2398-3795
• ISSN: 2398-3795
• Language: English
• Keywords: Paroxetine; Family medicine; Population; Statistics; Medicine; Descriptive statistics; Percentile; Medical prescription; Environmental health; Pharmacology; Retrospective cohort study; Psychiatry; Antidepressant; Anxiety; Psychology; Logistic regression; Primary care; Internal medicine