A drug utilisation study of antidepressants in children and adolescents using the General Practice Research Database

• Published in: Archives of disease in childhood Vol. 89; no. 12; pp. 1098 - 1102
• Main Authors: Murray, M L, de Vries, C S, Wong, I C K
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.12.2004; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Adolescent; Adolescents; Age; antidepressant; Antidepressants; Antidepressants, Tricyclic; Antidepressive Agents - therapeutic use; Anxiety Disorders; ATD; Biological and medical sciences; Child; Child, Preschool; Childhood depression; Children; Depression (Psychology); Depression in children; Depressive Disorder - drug therapy; Dosage and administration; Drug Prescriptions - statistics & numerical data; Drug therapy; Drug Utilization - statistics & numerical data; Evaluation; Family Practice - statistics & numerical data; Female; Gender Differences; General aspects; General Practice Research Database; GPRD; hazard ratio; Health aspects; Humans; Infant; Infant, Newborn; Male; MAOI; Medical sciences; Mental depression; Mental Disorders; monoamine oxidase inhibitor; Obsessive compulsive disorder; OCD; Original; Patient outcomes; Population; Practice Patterns, Physicians' - statistics & numerical data; Practice research; prescribing trends; Prescriptions; Psychological Patterns; randomised controlled trial; RCT; Records (Forms); selective serotonin reuptake inhibitor; Selective serotonin reuptake inhibitors; Serotonin uptake inhibitors; SSRI; Suicides & suicide attempts; Survival Analysis; TCA; Teenagers; tricyclic antidepressant; Tricyclic antidepressants; United Kingdom; Urinary incontinence; United Kingdom; Europe; United Kingdom > UK; Human; Consumption; Pediatrics; Psychotropic; Adolescent; Database; Antidepressant agent; General practice; Child; Statistical study; Public health
• ISSN: 0003-9888; 1468-2044; 1468-2044
• DOI: 10.1136/adc.2004.064956

Aims: To characterise prescribing patterns of antidepressants (ATDs) to children and adolescents aged ⩽18 years in the UK. Methods: Subjects issued at least one ATD prescription between 1 January 1992 and 31 December 2001 were identified from the UK General Practice Research Database. Prescribing patterns, annual prevalence, morbidity patterns, and time to discontinuation of ATD use were identified. Results: A total of 24 976 subjects received 93 091 prescriptions; 51 868 (55.7%), 38 429 (41.3%), and 2708 (2.9%) prescriptions were for tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and other ATDs respectively. ATD prevalence increased 1.7-fold from 1992 to 2001. TCA prevalence decreased by 30% from 3.6 to 2.5 per 1,000; SSRI prevalence increased 10 times from 0.5 to 4.6 per 1,000. In new ATD users aged ⩽10 years, the most common diagnosis associated with TCA use was nocturnal enuresis (75.1%); in those aged ⩾15 years, it was depression (45.8%). Depression was also associated with SSRI use (69.0%). For new users with depression, the median treatment durations for TCAs and SSRIs were 30 and 58 days respectively. TCA users were more likely to terminate treatment than SSRI users (TCAs v fluoxetine: 1.40, 95% CI 1.32 to 1.47; non-fluoxetine SSRIs v fluoxetine: 1.01, 95% CI 0.96 to 1.07). Conclusions: SSRIs have gained popularity for the treatment of depression compared with TCAs. TCAs are still used despite their lack of efficacy in prepubertal depression and their moderate effect in adolescents. However, >50% of subjects discontinue treatment after two months, with TCA users stopping earlier than SSRI users.