What were the impacts of the Committee on Safety of Medicines warning and publication of the NICE guidelines on trends in child and adolescent antidepressant prescribing in primary care? A population based study.
OBJECTIVES: To assess the impact of both the Committee on Safety of Medicines (CSM) warning (December 2003) and the National Institute for Health and Care Excellence (NICE) guidance (September 2005) on antidepressant prescription rates in children and adolescents within the UK primary care service.
SETTING: Population based study of primary care antidepressant prescribing using the Clinical Practice Research Datalink (CPRD).
PARTICIPANTS: Under-18s presenting to primary care with a depressive disorder or related diagnostic code recorded in the CPRD.
PRIMARY OUTCOME MEASURE: Antidepressant prescription rates per month per 100 000 depressed 4-17 year olds.
RESULTS: Following the CSM warning, the prior trend towards increased prescribing rates for selective serotonin reuptake inhibitors (SSRIs) in children was significantly reversed (beta for change in trend -12.34 (95% CI -18.67 to -6.00, p<0.001)). However, after the publication of the NICE guidelines the prior trend towards increased prescribing resumed for those SSRIs mentioned as potential treatments in the guidance (fluoxetine, citalopram and sertraline) (beta for change in trend 11.52 (95% CI 5.32 to 17.73, p<0.001)). Prescribing of other SSRIs and tricyclics remained low.
CONCLUSIONS: Despite a strong emphasis on psychosocial interventions for child and adolescent depression, it may be that the NICE guidelines inadvertently encouraged further antidepressant prescribing, at least for those SSRIs cited. Although the guidelines gave cautions and caveats for the use of antidepressants, practitioners may have interpreted these recommendations as endorsing their use in young people with depression and related conditions. However, more accurate prevalence trend estimates for depression in this age group, and information on the use of psychosocial interventions would be needed to rule out other reasons underlying this increase in prescribing.
|投稿者||Tiffin, Paul A; Mediavilla, Jose L; Close, Helen; Kasim, Adetayo S; Welsh, Patrick; Paton, Lewis W; Mason, James M|
|組織名||Department of Health Sciences, University of York, York, UK.;Health Professions Education Unit, Hull York Medical School, York, UK.;Darlington Community Team for Children and Young People, Tees Esk and Wear;Valleys NHS Foundation Trust, Middlesbrough, UK.;The Research Design Service North East and Cumbria, Institute of Health and;Society, University of Newcastle, Newcastle, UK.;Wolfson Research Institute for Health and Wellbeing, Durham University,;Stockton-on-Tees, UK.;Warwick Medical School, University of Warwick, Coventry, UK.|