What factors influence long-term antidepressant use in primary care? Findings from the Australian diamond cohort study

Gilles Ambresin; Victoria Palmer; Konstancja Densley; Christopher Dowrick; Gail Gilchrist; Jane M Gunn

doi:10.1016/j.jad.2015.01.055

What factors influence long-term antidepressant use in primary care? Findings from the Australian diamond cohort study

J Affect Disord. 2015 May 1:176:125-32. doi: 10.1016/j.jad.2015.01.055. Epub 2015 Feb 2.

Authors

Gilles Ambresin¹, Victoria Palmer², Konstancja Densley², Christopher Dowrick³, Gail Gilchrist⁴, Jane M Gunn²

Affiliations

¹ General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia; University Institute of Psychotherapy, Department of Psychiatry-CHUV, University of Lausanne, Switzerland. Electronic address: gilles.ambresin@chuv.ch.
² General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia.
³ Primary Medical Care, University of Liverpool. Liverpool, United Kingdom.
⁴ National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.

PMID: 25704565
DOI: 10.1016/j.jad.2015.01.055

Abstract

Background: Antidepressants are one of the most commonly prescribed drugs in primary care. The rise in use is mostly due to an increasing number of long-term users of antidepressants (LTU AD). Little is known about the factors driving increased long-term use. We examined the socio-demographic, clinical factors and health service use characteristics associated with LTU AD to extend our understanding of the factors that may be driving the increase in antidepressant use.

Methods: Cross-sectional analysis of 789 participants with probable depression (CES-D≥16) recruited from 30 randomly selected Australian general practices to take part in a ten-year cohort study about depression were surveyed about their antidepressant use.

Results: 165 (21.0%) participants reported <2 years of antidepressant use and 145 (18.4%) reported ≥2 years of antidepressant use. After adjusting for depression severity, LTU AD was associated with: single (OR 1.56, 95%CI 1.05-2.32) or recurrent episode of depression (3.44, 2.06-5.74); using SSRIs (3.85, 2.03-7.33), sedatives (2.04, 1.29-3.22), or antipsychotics (4.51, 1.67-12.17); functional limitations due to long-term illness (2.81, 1.55-5.08), poor/fair self-rated health (1.57, 1.14-2.15), inability to work (2.49, 1.37-4.53), benefits as main source of income (2.15, 1.33-3.49), GP visits longer than 20min (1.79, 1.17-2.73); rating GP visits as moderately to extremely helpful (2.71, 1.79-4.11), and more self-help practices (1.16, 1.09-1.23).

Limitations: All measures were self-report. Sample may not be representative of culturally different or adolescent populations. Cross-sectional design raises possibility of "confounding by indication".

Conclusions: Long-term antidepressant use is relatively common in primary care. It occurs within the context of complex mental, physical and social morbidities. Whilst most long-term use is associated with a history of recurrent depression there remains a significant opportunity for treatment re-evaluation and timely discontinuation.

Keywords: Antidepressive agents; Depression; Depressive disorder; Treatment outcome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Antidepressive Agents / administration & dosage*
Antidepressive Agents / therapeutic use*
Australia
Cohort Studies
Cross-Sectional Studies
Depression / drug therapy*
Female
Humans
Male
Patient Acceptance of Health Care
Primary Health Care*
Self Report
Socioeconomic Factors
Time Factors

Substances

Antidepressive Agents