TY - JOUR

T1 - Early discontinuation of antidepressants in general practice

T2 - association with patient and prescriber characteristics

AU - Hansen, Dorte Gilså

AU - Vach, Werner

AU - Rosholm, Jens-Ulrik

AU - Søndergaard, Jens

AU - Gram, Lars F

AU - Kragstrup, Jakob

PY - 2004/12

Y1 - 2004/12

N2 - BACKGROUND: Most antidepressant treatment is initiated and continued in general practice but, despite current guidelines, treatment duration is often short among patients with depression. Discontinuation may, however, be caused by a complexity of factors, but so far research has focused on drug effects, adverse effects and drug regimens.OBJECTIVE: Our aim was to analyse whether early discontinuation of first-time antidepressant treatment in general practice may be predicted by (i) social position and psychiatric history of the patient; and (ii) demography, practice activity and the general prescribing behaviour of the GP.METHODS: Early discontinuation, i.e. that patients do not purchase antidepressants in the 6 months following first prescription, was analysed using established databases. Among patients presenting in 174 general practices in Funen County, Denmark, 4860 adult first-time users of antidepressants were identified (regardless of diagnosis). The inclusion period was January 1998-June 1999.RESULTS: One in three patients did not purchase antidepressants in the 6 months following first prescription, but rates were higher among those prescribed tricyclic compared with new generation antidepressants. Patients' age and sex did not have an influence, but early discontinuation was more frequent among patients of low socio-economic status and patients prescribed in practices characterized by high prescribing rates. No association with psychiatric history was observed.CONCLUSION: Early discontinuation is frequent in general practice, and patients of low social status are at greater risk. Adherence-promoting strategies should pay attention to the high prescribing doctors. Further studies may answer the question of whether the association between doctors' prescribing behaviour and early discontinuation is a feature specific to antidepressants or a more general phenomenon.

AB - BACKGROUND: Most antidepressant treatment is initiated and continued in general practice but, despite current guidelines, treatment duration is often short among patients with depression. Discontinuation may, however, be caused by a complexity of factors, but so far research has focused on drug effects, adverse effects and drug regimens.OBJECTIVE: Our aim was to analyse whether early discontinuation of first-time antidepressant treatment in general practice may be predicted by (i) social position and psychiatric history of the patient; and (ii) demography, practice activity and the general prescribing behaviour of the GP.METHODS: Early discontinuation, i.e. that patients do not purchase antidepressants in the 6 months following first prescription, was analysed using established databases. Among patients presenting in 174 general practices in Funen County, Denmark, 4860 adult first-time users of antidepressants were identified (regardless of diagnosis). The inclusion period was January 1998-June 1999.RESULTS: One in three patients did not purchase antidepressants in the 6 months following first prescription, but rates were higher among those prescribed tricyclic compared with new generation antidepressants. Patients' age and sex did not have an influence, but early discontinuation was more frequent among patients of low socio-economic status and patients prescribed in practices characterized by high prescribing rates. No association with psychiatric history was observed.CONCLUSION: Early discontinuation is frequent in general practice, and patients of low social status are at greater risk. Adherence-promoting strategies should pay attention to the high prescribing doctors. Further studies may answer the question of whether the association between doctors' prescribing behaviour and early discontinuation is a feature specific to antidepressants or a more general phenomenon.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Antidepressive Agents/classification

KW - Antidepressive Agents, Tricyclic/therapeutic use

KW - Denmark

KW - Drug Prescriptions

KW - Drug Utilization/statistics & numerical data

KW - Family Practice/standards

KW - Female

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Patient Compliance/statistics & numerical data

KW - Practice Patterns, Physicians'/statistics & numerical data

KW - Registries

KW - Socioeconomic Factors

U2 - 10.1093/fampra/cmh608

DO - 10.1093/fampra/cmh608

M3 - Journal article

C2 - 15520034

VL - 21

SP - 623

EP - 629

JO - Family Practice

JF - Family Practice

SN - 0263-2136

IS - 6

ER -