GPs urged to check SSRI doses

More than a quarter of patients on antidepressants may be on the wrong dose and reviews by GPs could slash NHS costs, UK research suggests.

Antidepressant prescriptions have continued to rise (Photograph: Ian Hooton/SPL)
Antidepressant prescriptions have continued to rise (Photograph: Ian Hooton/SPL)

Structured reviews of patients on antidepressants for at least two years found that 28.5% needed their therapy adjusted.

Subsequent changes to prescriptions saved 8.1% of antidepressant drug costs, totalling £23,320 across 71 GP practices. Conducted nationally, this could save up to £21.9m from England's £270m annual bill for antidepressants.

Researchers also warned that higher SSRI doses may be contributing to the growth in antidepressant use. Antidepressant prescriptions have continued to rise despite GP consultations for depression falling by half since 2003/4.

In the study, researchers collected data from 71 Scottish practices in deprived urban areas that took part in a Scottish government review of antidepressant prescribing.

Patients were excluded if they were under 18, receiving psychiatric care, had received a review in the past six months or were on the QOF severe mental health register.

Practices reviewed 18.2% of patients on antidepressants on their lists, a total of 2,849, between December 2009 and March 2010. Data supplied by GPs included daily dose, indication, changes in antidepressant therapy and onward referral.

Researchers found that 28.5% of reviews resulted in a change of therapy. This included 5.3% who had their dose increased and 12.8% who had their dose reduced. One in 14 patients had their medication withdrawn. A total of 6.8% of patients were referred to support, such as mental health services and social services.

Researchers suggested the QOF should support management of depression as a long-term condition to encourage regular reviews.

They added: 'It may be more efficacious to change compliant nonand poor responders to a different SSRI, rather than increasing the dose.'

QOF indicators for depression currently target checks for severity for recently diagnosed cases and case finding in patients with diabetes.

  • BJGP 2012; 62: 584-5

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