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Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study

A. John, A. L. Marchant, D. L. Fone, J. I. McGregor, M. S. Dennis, J. O. A. Tan, K. Lloyd, Keith Lloyd Orcid Logo, Michael Dennis, Joanna McGregor Orcid Logo, Ann John Orcid Logo, Amanda Marchant Orcid Logo

Psychological Medicine, Volume: 46, Issue: 16, Pages: 3315 - 3327

Swansea University Authors: Keith Lloyd Orcid Logo, Michael Dennis, Joanna McGregor Orcid Logo, Ann John Orcid Logo, Amanda Marchant Orcid Logo

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DOI (Published version): 10.1017/s0033291716002099

Abstract

Concerns relating to increased use of psychotropic medication contrast with those of under-treatment and under-recognition of common mental disorders in children and young people (CYP) across developed countries. Little is known about the indications recorded for antidepressant prescribing in primar...

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Published in: Psychological Medicine
ISSN: 0033-2917 1469-8978
Published: 2016
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URI: https://cronfa.swan.ac.uk/Record/cronfa34070
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Little is known about the indications recorded for antidepressant prescribing in primary care in CYP.This was an electronic cohort study of routinely collected primary-care data from a population of 1.9 million, Wales, UK. Poisson regression was undertaken to model adjusted counts of recorded depression symptoms, diagnoses and antidepressant prescriptions. Associated indications were explored.3 58 383 registered patients aged 6-18 years between 1 January 2003 and 31 December 2013 provided a total of 19 20 338 person-years of follow-up. The adjusted incidence of antidepressant prescribing increased significantly [incidence rate ratio (IRR) for 2013 = 1.28], mainly in older adolescents. The majority of new antidepressant prescriptions were for citalopram. Recorded depression diagnoses showed a steady decline (IRR = 0.72) while depression symptoms (IRR = 2.41) increased. Just over half of new antidepressant prescriptions were associated with depression (diagnosis or symptoms). Other antidepressant prescribing, largely unlicensed, was associated with diagnoses such as anxiety and pain.Antidepressant prescribing is increasing in CYP while recorded depression diagnoses decline. Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose. Unlicensed antidepressant prescribing is associated with a wide range of diagnoses, and while accepted practice, is often not supported by safety and efficacy studies. New strategies to implement current guidance for the management of depression in CYP are required.</abstract><type>Journal Article</type><journal>Psychological Medicine</journal><volume>46</volume><journalNumber>16</journalNumber><paginationStart>3315</paginationStart><paginationEnd>3327</paginationEnd><publisher/><issnPrint>0033-2917</issnPrint><issnElectronic>1469-8978</issnElectronic><keywords/><publishedDay>31</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2016</publishedYear><publishedDate>2016-12-31</publishedDate><doi>10.1017/s0033291716002099</doi><url/><notes/><college>COLLEGE NANME</college><department>Medicine, Health and Life Science - Faculty</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>FGMHL</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2020-06-22T16:26:59.9529854</lastEdited><Created>2017-05-31T15:39:36.2394468</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>A.</firstname><surname>John</surname><order>1</order></author><author><firstname>A. L.</firstname><surname>Marchant</surname><order>2</order></author><author><firstname>D. L.</firstname><surname>Fone</surname><order>3</order></author><author><firstname>J. I.</firstname><surname>McGregor</surname><order>4</order></author><author><firstname>M. S.</firstname><surname>Dennis</surname><order>5</order></author><author><firstname>J. O. 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spelling 2020-06-22T16:26:59.9529854 v2 34070 2017-05-31 Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study a13aaa0df9045c205e82ed3b95d18c10 0000-0002-1440-4124 Keith Lloyd Keith Lloyd true false e2fb156498bd28a936b34e986dfa01b7 Michael Dennis Michael Dennis true false caa651da7e3807cbeac8ec2f40643677 0000-0003-0242-4600 Joanna McGregor Joanna McGregor true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 0776f450dd575004ba7c69930c579cae 0000-0001-7013-6980 Amanda Marchant Amanda Marchant true false 2017-05-31 FGMHL Concerns relating to increased use of psychotropic medication contrast with those of under-treatment and under-recognition of common mental disorders in children and young people (CYP) across developed countries. Little is known about the indications recorded for antidepressant prescribing in primary care in CYP.This was an electronic cohort study of routinely collected primary-care data from a population of 1.9 million, Wales, UK. Poisson regression was undertaken to model adjusted counts of recorded depression symptoms, diagnoses and antidepressant prescriptions. Associated indications were explored.3 58 383 registered patients aged 6-18 years between 1 January 2003 and 31 December 2013 provided a total of 19 20 338 person-years of follow-up. The adjusted incidence of antidepressant prescribing increased significantly [incidence rate ratio (IRR) for 2013 = 1.28], mainly in older adolescents. The majority of new antidepressant prescriptions were for citalopram. Recorded depression diagnoses showed a steady decline (IRR = 0.72) while depression symptoms (IRR = 2.41) increased. Just over half of new antidepressant prescriptions were associated with depression (diagnosis or symptoms). Other antidepressant prescribing, largely unlicensed, was associated with diagnoses such as anxiety and pain.Antidepressant prescribing is increasing in CYP while recorded depression diagnoses decline. Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose. Unlicensed antidepressant prescribing is associated with a wide range of diagnoses, and while accepted practice, is often not supported by safety and efficacy studies. New strategies to implement current guidance for the management of depression in CYP are required. Journal Article Psychological Medicine 46 16 3315 3327 0033-2917 1469-8978 31 12 2016 2016-12-31 10.1017/s0033291716002099 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 2020-06-22T16:26:59.9529854 2017-05-31T15:39:36.2394468 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine A. John 1 A. L. Marchant 2 D. L. Fone 3 J. I. McGregor 4 M. S. Dennis 5 J. O. A. Tan 6 K. Lloyd 7 Keith Lloyd 0000-0002-1440-4124 8 Michael Dennis 9 Joanna McGregor 0000-0003-0242-4600 10 Ann John 0000-0002-5657-6995 11 Amanda Marchant 0000-0001-7013-6980 12 0034070-13092017113015.pdf recent_trends_in_primarycare_antidepressant_prescribing_to_children_and_young_people_an_ecohort_study.pdf 2017-09-13T11:30:15.6630000 Output 366324 application/pdf Version of Record true 2017-09-13T00:00:00.0000000 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. true eng
title Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study
spellingShingle Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study
Keith Lloyd
Michael Dennis
Joanna McGregor
Ann John
Amanda Marchant
title_short Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study
title_full Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study
title_fullStr Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study
title_full_unstemmed Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study
title_sort Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study
author_id_str_mv a13aaa0df9045c205e82ed3b95d18c10
e2fb156498bd28a936b34e986dfa01b7
caa651da7e3807cbeac8ec2f40643677
ed8a9c37bd7b7235b762d941ef18ee55
0776f450dd575004ba7c69930c579cae
author_id_fullname_str_mv a13aaa0df9045c205e82ed3b95d18c10_***_Keith Lloyd
e2fb156498bd28a936b34e986dfa01b7_***_Michael Dennis
caa651da7e3807cbeac8ec2f40643677_***_Joanna McGregor
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
0776f450dd575004ba7c69930c579cae_***_Amanda Marchant
author Keith Lloyd
Michael Dennis
Joanna McGregor
Ann John
Amanda Marchant
author2 A. John
A. L. Marchant
D. L. Fone
J. I. McGregor
M. S. Dennis
J. O. A. Tan
K. Lloyd
Keith Lloyd
Michael Dennis
Joanna McGregor
Ann John
Amanda Marchant
format Journal article
container_title Psychological Medicine
container_volume 46
container_issue 16
container_start_page 3315
publishDate 2016
institution Swansea University
issn 0033-2917
1469-8978
doi_str_mv 10.1017/s0033291716002099
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description Concerns relating to increased use of psychotropic medication contrast with those of under-treatment and under-recognition of common mental disorders in children and young people (CYP) across developed countries. Little is known about the indications recorded for antidepressant prescribing in primary care in CYP.This was an electronic cohort study of routinely collected primary-care data from a population of 1.9 million, Wales, UK. Poisson regression was undertaken to model adjusted counts of recorded depression symptoms, diagnoses and antidepressant prescriptions. Associated indications were explored.3 58 383 registered patients aged 6-18 years between 1 January 2003 and 31 December 2013 provided a total of 19 20 338 person-years of follow-up. The adjusted incidence of antidepressant prescribing increased significantly [incidence rate ratio (IRR) for 2013 = 1.28], mainly in older adolescents. The majority of new antidepressant prescriptions were for citalopram. Recorded depression diagnoses showed a steady decline (IRR = 0.72) while depression symptoms (IRR = 2.41) increased. Just over half of new antidepressant prescriptions were associated with depression (diagnosis or symptoms). Other antidepressant prescribing, largely unlicensed, was associated with diagnoses such as anxiety and pain.Antidepressant prescribing is increasing in CYP while recorded depression diagnoses decline. Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose. Unlicensed antidepressant prescribing is associated with a wide range of diagnoses, and while accepted practice, is often not supported by safety and efficacy studies. New strategies to implement current guidance for the management of depression in CYP are required.
published_date 2016-12-31T03:42:17Z
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