Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database

doi:10.1136/bmj.b3999

Published 15 October 2009, doi:10.1136/bmj.b3999
Cite this as: BMJ 2009;339:b3999

Research

Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database

Michael Moore, senior lecturer¹, Ho Ming Yuen, medical statistician², Nick Dunn, director of GP teaching³, Mark A Mullee, director, research design service south central², Joe Maskell, data manager², Tony Kendrick, professor of primary medical care¹

¹ University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, ² Public Health Sciences and Medical Statistics, University of Southampton, Southampton SO16 6YD, ³ Division of Medical Education, School of Medicine, University of Southampton, Southampton SO16 7PX

Correspondence to: Michael Moore mvm198{at}soton.ac.uk

Objective To explore the reasons behind the recent increasein antidepressant prescribing in the United Kingdom.

Design Detailed retrospective analysis of data on general practitionerconsultations and antidepressant prescribing.

Data source Data were obtained from the general practice researchdatabase, which contains linked anonymised records of over 3million patients registered in the UK. Data were extracted forall new incident cases of depression between 1993 and 2005.

Review methods Detailed analysis of general practitioner consultationsand antidepressant prescribing was restricted to 170 practicesthat were contributing data for the full duration of the study.

Results In total, 189 851 people within the general practiceresearch database experienced their first episode of depressionbetween 1993 and 2005, of whom 150 825 (79.4%) received a prescriptionfor antidepressants in the first year of diagnosis. This proportionremained stable across all the years examined. The incidenceof new cases of depression rose in young women but fell slightlyin other groups such that overall incidence increased then declinedslightly (men: 7.83 cases per 1000 patient years in 1993 to5.97 in 2005, women: 15.83 cases per 1000 patient years in 1993to 10.06 in 2005). Antidepressant prescribing nearly doubledduring the study period—the average number of prescriptionsissued per patient increased from 2.8 in 1993 to 5.6 in 2004.The majority of antidepressant prescriptions were given as longterm treatment or as intermittent treatment to patients withmultiple episodes of depression.

Conclusions The rise in antidepressant prescribing is mainlyexplained by small changes in the proportion of patients receivinglong term treatment. Previous clinical guidelines have focusedon antidepressant initiation and appropriate targeting of antidepressants.To address the costly rise in antidepressant prescribing, futureresearch and guidance needs to concentrate on appropriate longterm prescribing for depression and regular review of medication.

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