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. 2004 Dec;89(12):1098–1102. doi: 10.1136/adc.2004.064956

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

M Murray 1, C S de Vries 1, I Wong 1
PMCID: PMC1719765  PMID: 15557040

Abstract

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.

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Figure 1.

Figure 1

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 Proportions of antidepressant (ATD) use by year and drug group—tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), other antidepressants (flupentixol, mirtazapine, nefazodone, reboxetine, tryptophan, venlafaxine), and monoamine oxidase inhibitors (MAOI).

Figure 2.

Figure 2

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 Age-sex distribution of study population (age at first recorded antidepressant (ATD) prescription).

Figure 3.

Figure 3

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 Prevalence of tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRI) by age and sex in 1992 and 2001. *There were few 0 year old subjects registered on the GPRD, so the prevalence was not presented as the figures were unstable.

Figure 4.

Figure 4

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 Estimated survival curves for new users first treated with fluoxetine, non-fluoxetine selective serotonin reuptake inhibitors (SSRIs), or tricyclic antidepressants (TCAs) by Cox regression analysis adjusted by age and sex.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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