Quarter of antidepressant users 'on wrong dose'

A quarter of patients on long-term antidepressants may benefit from a change in dose and a simple review by GPs could stem rising drug use and reduce NHS bills, research has found.

Patients on antidepressants benefit from regular reviews of their medication
Patients on antidepressants benefit from regular reviews of their medication

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

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 recent growth in antidepressant use.

Antidepressant prescriptions have continued to rise despite GP consultations for depression falling by half since 2003/4.

In the BJGP study, researchers collected data from 71 Scottish practices in deprived urban areas that took part in the Scottish government’s project to review 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 several mental health register in QOF.

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

Researchers found 28.5% of reviews resulted in a change of antidepressant 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 One in 14 patients had their medication withdrawn.

Just 6.8% of patients were referred to support such as mental health services and social services.

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

They added: ‘It may be more efficacious to change compliant non- and poor-SSRI 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.

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