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. 2017 Mar 1:210:312-318.
doi: 10.1016/j.jad.2016.12.047. Epub 2017 Jan 2.

Temporal trends in antidepressant prescribing to children in UK primary care, 2000-2015

Jane Sarginson  1 , Roger T Webb  2 , S Jill Stocks  3 , Aneez Esmail  3 , Shruti Garg  4 , Darren M Ashcroft  5
Affiliations

Temporal trends in antidepressant prescribing to children in UK primary care, 2000-2015

Jane Sarginson et al. J Affect Disord. .

Abstract

Background: The prevalence of antidepressant prescribing in children and adolescents increased steadily in the United States and parts of Europe between 2005 and 2012 despite regulatory safety warnings. Little is known about the characteristics of those being prescribed antidepressants for the first time.

Methods: A longitudinal study of antidepressant prescribing in 3-17 year olds was carried out using data from the UK Clinical Practice Research Datalink (CPRD) between 2000 and 2015. Changes in the incidence of first ever antidepressant prescriptions and the characteristics of those being prescribed them was examined.

Results: Incidence of first ever prescriptions nearly doubled between 2006 and 2015 rising from 1.60 (95%CI: 1.51, 1.69) to 3.12 (3.00, 3.25) per 1000 person years. Only 21% of the 1721 patients with incident prescriptions in 2015 could be linked to a depression diagnosis, with an additional 22% of prescriptions linked to alternative indications. The incidence of prescriptions linked to a depression diagnosis increased between 2012 and 2015, with an adjusted incidence rate ratio of 1.46 (1.26, 1.70). Antidepressant prescribing for depression and other indications has been increasing most rapidly in 15 to 17 year old females.

Limitations: Diagnoses are not directly linked to prescriptions in CPRD, so linkage must be inferred by temporal proximity.

Conclusions: Antidepressant prescribing in children increased between 2006 and 2015. This is, at least in part, due to a rise in alternative uses of antidepressants, including the treatment of anxiety, chronic pain and migraines.

Keywords: Antidepressant; Children; Depression; UK.

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Figures

Fig. 1
Fig. 1
Flow chart for assignment of 6–17 year olds with a first ever antidepressant prescription in 2015 by prescribing indication. A code recorded 12 week before to 4 weeks after the first ever prescription was considered to be contemporary. A contemporary recording of a depression diagnosis code was considered to be the primary reason for the antidepressant prescription followed by level 1, then level 2 diagnostic code groupings. Level 1 diagnostic code groups are for conditions that have antidepressant use included in age appropriated NICE guidelines or the BNF for children. Levels 2 were either identified in a survey of codes recorded on the day of the first ever prescription in 2015 or consist of symptom codes. *Less than 5 events recorded.
Fig. 2
Fig. 2
Changes in rates of 3–17 year olds starting antidepressant treatment for the first time, Key: (1) The investigative program Panorama raises concerns about the use of the SSRI paroxetine in children. (2) The FDA request that GlaxoSmithKline provide clinical trial data of paroxetine in children revealing an increased risk of suicidal behaviour. (3) The FDA and MHRA complete investigations into antidepressant safety and efficacy in children. (4) The FDA requires that safety warnings be added to antidepressants. (5) NICE introduces guidelines for the treatment of depression in children which recommends limitations on antidepressant use.
Fig. 3
Fig. 3
Changes in incidence of first ever antidepressant prescriptions by age band and gender.
Fig. 4
Fig. 4
Changes over time in the incidence of first ever antidepressant prescriptions assigned to depression diagnosis vs depression symptom code groups.
See this image and copyright information in PMC

References

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