Trends in Depression and Antidepressant Prescribing in Children and Adolescents: A Cohort Study in The Health Improvement Network (THIN)
Trends in Depression and Antidepressant Prescribing in Children and Adolescents: A Cohort Study in The Health Improvement Network (THIN)
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DOI：
10.1371/journal.pone.0033181
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发表时间：
2012-03-13
期刊：
影响因子：
3.7
通讯作者：
Petersen, Irene
中科院分区：
文献类型：
--
作者：
Wijlaars, Linda P. M. M.;Nazareth, Irwin;Petersen, Irene
工作背景：2003年，药物安全委员会（CSM）建议不要使用氟西汀以外的选择性5-羟色胺再摄取抑制剂（SSRI）治疗儿童，因为可能会增加自杀行为的风险。本研究探讨了这种安全警告的影响，对全科医生的抑郁症诊断和处方behaviorinchild.Methods和调查结果：我们确定了一个队列的1,502,753名儿童（6米）的健康改善网络（THIN）英国初级保健数据库。研究了1995-2009年抑郁症诊断、症状和抗抑郁药处方发生率的趋势，考虑了剥夺、年龄和性别。我们使用分段回归分析来评估处方率的变化。总体而言，45，723名（3%）儿童在其临床记录中有>= 1个抑郁相关条目。16，925名儿童（1%）服用了SSRIs。SSRI处方率从2002年的3.2（95% CI：3.0，3.3）/1，000风险人年（PYAR）降至2005年的1.7（95% CI：1.7，1.8）/1，000 PYAR，但此后上升至2009年的2.7（95% CI：2.6，2.8）/1，000 PYAR。2002年后，CSM禁忌的SSRIs西酞普兰、舍曲林尤其是帕罗西汀的处方率急剧下降，而氟西汀和阿米替林的处方率保持稳定。2005年后，除帕罗西汀和丙咪嗪外，所有抗抑郁药的使用率再次开始上升。抑郁症诊断率从2002年的3.0（95% CI：2.8，3.1）/1，000 PYAR下降到2005年的2.0（95% CI：1.9，2.1）/1，000 PYAR，此后一直保持稳定。症状记录从1995年的1.0（95%CI：0.8，1.2）/1，000 PYAR稳步上升至2009年的4.7（95%CI：4.5，4.8）/1，000 PYAR。结论：抑郁症诊断率和SSRI处方率在CSM建议前后显著下降，而症状记录中没有出现这种情况。这可能表明全科医生在做出抑郁症诊断和按照CSM的建议开抗抑郁药时要谨慎。
Background: In 2003, the Committee on Safety of Medicines (CSM) advised against treatment with selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine in children, due to a possible increased risk of suicidal behaviour. This study examined the effects of this safety warning on general practitioners' depression diagnosing and prescription behaviour in children.Methods and Findings: We identified a cohort of 1,502,753 children (6 m) in The Health Improvement Network (THIN) UK primary care database. Trends in incidence of depression diagnoses, symptoms and antidepressant prescribing were examined 1995-2009, accounting for deprivation, age and gender. We used segmented regression analysis to assess changes in prescription rates. Overall, 45,723 (3%) children had >= 1 depression-related entry in their clinical records. SSRIs were prescribed to 16,925 (1%) of children. SSRI prescription rates decreased from 3.2 (95% CI:3.0,3.3) per 1,000 person-years at risk (PYAR) in 2002 to 1.7 (95% CI:1.7,1.8) per 1,000 PYAR in 2005, but have since risen to 2.7 (95% CI:2.6,2.8) per 1,000 PYAR in 2009. Prescription rates for CSM-contraindicated SSRIs citalopram, sertraline and especially paroxetine dropped dramatically after 2002, while rates for fluoxetine and amitriptyline remained stable. After 2005 rates for all antidepressants, except paroxetine and imipramine, started to rise again. Rates for depression diagnoses dropped from 3.0 (95% CI: 2.8,3.1) per 1,000 PYAR in 2002 to 2.0 (95% CI:1.9,2.1) per 1,000 PYAR in 2005 and have been stable since. Recording of symptoms saw a steady increase from 1.0 (95% CI:0.8,1.2) per 1,000 PYAR in 1995 to 4.7 (95% CI:4.5,4.8) per 1,000 PYAR in 2009.Conclusions: The rates of depression diagnoses and SSRI prescriptions showed a significant drop around the time of the CSM advice, which was not present in the recording of symptoms. This could indicate caution on the part of GPs in making depression diagnoses and prescribing antidepressants following the CSM advice.