Infrequent use of antidepressants in depressed individuals (an interview and prescription database study in a defined Swedish population 2001-2002)

Effect of work schedule on prospective antidepressant prescriptions in Sweden: a 2-year sex-stratified analysis using national drug registry data

INTRODUCTION

Depression-related mood disorders affect millions of people worldwide and contribute to substantial morbidity and disability, yet little is known about the effects of work scheduling on depression. This study used a large Swedish survey to prospectively examine the effects of work schedule on registry-based antidepressant prescriptions in females and males over a 2-year period.

METHODS

The study was based on an approximately representative sample (n=3980 males, 4663 females) of gainfully employed participants in the Swedish Longitudinal Occupational Survey of Health. Sex-stratified analyses were conducted using logistic regression. For exposure, eight categories described work schedule in 2008: 'regular days' (three categories of night work history: none, ≤3 years, 4+ years), 'night shift work', 'regular shift work (no nights)', 'rostered work (no nights)', 'flexible/non-regulated hours' and 'other'. For the primary outcome measure, all prescriptions coded N06A according to the Anatomical Therapeutic Chemical System were obtained from the Swedish National Prescribed Drug Register and dichotomised into 'any' or 'no' prescriptions between 2008 and 2010. Estimates were adjusted for potential sociodemographic, health and work confounders, and for prior depressive symptoms.

RESULTS

In 2008, 22% of females versus 19% of males worked outside of regular daytime schedule. Registered antidepressant prescription rates in the postsurvey period were 11.4% for females versus 5.8% for males. In fully adjusted models, females in 'flexible/non-regulated' schedules showed an increased OR for prospective antidepressant prescriptions (OR=2.01, 95% CI=1.08 to 3.76). In males, odds ratios were most increased in those working 'other' schedules (OR=1.72, 95% CI=0.75 to 3.94) and 'Regular days with four or more years' history of night work' (OR=1.54, 95% CI=0.93 to 2.56).

CONCLUSIONS

This study's findings support a relationship between work schedule and prospective antidepressant prescriptions in the Swedish workforce. Future research should continue to assess sex-stratified relationships, using detailed shift work exposure categories and objective registry data where possible.

Children's age at parental divorce and depression in early and mid-adulthood

This study aimed to assess whether children's age at their parents' divorce is associated with depression in early and mid-adulthood, as indicated by medication purchase. A sibling comparison method was used to control for unobserved factors shared between siblings. The data were extracted from the Norwegian Population Register and Norwegian Prescription Database and included about 181,000 individuals aged 20-44 who had experienced parental divorce and 636,000 who had not. Controlling for age in 2004, sex, and birth order, children who were aged 15-19 when their parents divorced were 12 per cent less likely to purchase antidepressants as adults in 2004-08 than those experiencing the divorce aged 0-4. The corresponding reduction for those aged 20+ at the time of divorce was 19 per cent. However, the association between age at parental divorce and antidepressant purchases was only evident among women and those whose mothers had low education.

Association between prescribed antidepressants and other prescribed drugs differ by gender: a nationwide register-based study in Sweden

BACKGROUND

People with depression are prescribed more drugs than people in general, partly due to comorbidity with other conditions. However, little research has been done on depression-related drug use from a gender perspective.

AIM

Examine the association between antidepressants, other types of prescribed drugs, and polypharmacy, by gender.

METHODS

Data on drugs dispensed October to December 2016 to all Swedish citizens aged 18-84 years were collected from the Swedish prescribed drug register. Logistic regression analyses were performed to examine the associations between antidepressants and other drugs, by gender.

RESULTS

For both men and women, associations were found between antidepressants and drugs for alimentary tract problems, respiratory problems, blood, nervous system, analgesics, and polypharmacy. However, for women, but not men, associations were also found for drugs for diabetes, musculoskeletal problems, dermatological problems, and systemic hormones.

CONCLUSIONS

Associations were found between antidepressants and many other types of drugs for both men and women; indicating comorbidity between depression and other conditions. Further, some of the associations between antidepressants and other drugs were found to be specific among women. Whether this indicates that men and women differ in comorbidity between depression and other conditions cannot be concluded based on this cross-sectional study. However, comorbidity impairs the possibility of recovery; in the somatic condition as well as the depression. Thus, physicians need to be aware that the association between antidepressants and other types of drugs are more common among women than men.

Are men under-treated and women over-treated with antidepressants? Findings from a cross-sectional survey in Sweden

Aims and method To examine gender differences in self-reported depression and prescribed antidepressants (ADs). The Hospital Anxiety and Depression Scale was used to assess depression, and information on prescribed ADs was obtained from the Swedish Prescribed Drug Register. Results Depression was reported by 11.7% of the participants (12.3% men and 11.2% women). ADs were prescribed for 7.6% of the participants (5.3% men, 9.8% women). Among men, 1.8% reported depression and used ADs, 10.5% reported depression but did not use ADs, and 3.6% used ADs but did not report depression. The corresponding figures for women were 2.6%, 8.6% and 7.2%. Clinical implications Men report depression to a greater extent than women but are prescribed ADs to a lesser extent, possibly a sign of under-treatment. Women are prescribed ADs without reporting depression more often than men, possibly a sign of over-treatment. Although the causes remain unclear, diagnostic and treatment guidelines should benefit from considering gender differences in these respects.

Fertility history and use of antidepressant medication in late mid-life: a register-based analysis of Norwegian women and men

OBJECTIVES

Life course influences on later life depression may include parenting trajectories. We investigate associations between number and timing of births and use of antidepressant medication in late mid-life using data on the whole Norwegian population.

METHODS

We estimated logistic regression models to analyse variations in the purchase of antidepressants between 2004 and 2008 by timing of births and number of children among women and men aged 45-73, using Norwegian population register data. We controlled for age, education, marital and partnership status, and (in some models) family background shared among siblings.

RESULTS

Mothers and fathers of two or more children were generally less likely to purchase antidepressants than the childless. Mothers who started childbearing before age 22 were an exception, although according to sibling models they were not more likely to purchase antidepressants. All models showed that women who became mothers before age 26 and had only one child had higher odds of medication purchase than the childless. Older age at first birth was generally associated with lower risks of antidepressant purchase.

CONCLUSION

This analysis of high-quality data for a national population indicates that early motherhood, childlessness and low parity are associated with higher usage of antidepressants in late mid-life. Our data did not allow identification of mediating pathways, and we lacked information on early mental and physical health and some other potentially important confounders not shared between siblings. Furthermore purchase of antidepressants is not a perfect indicator of depression. Those concerns aside, the results suggest complex effects of fertility on depression that merit further investigation.

Purchases of Prescription Antidepressants in the Swedish Population in Relation to Major Workplace Downsizing

Organizational downsizing may be a risk factor for morbidity among both the displaced and those who remain in work. However, the knowledge is limited regarding its impact on clinically relevant mental health problems. Our objective was to investigate purchases of prescription antidepressants across 5 years in relation to workplace downsizing. We studied all Swedish residents 2004 throughout 2010, 22-54 years old in 2006, gainfully employed, and with a stable labor market position up to 2006. People primarily employed at a workplace with ≥18% staff reduction were considered exposed to major downsizing (in 2006-2007, 2007-2008, or 2008-2009). We applied repeated measures regression analyses through generalized estimating equations, calculating odds of any purchase of prescription antidepressants (inferred from the prescribed drug register) within five 12-month periods from 2 years before to 2 years after the period of major downsizing and compared the trends for newly exposed (n = 632,500) and unexposed (n = 1,021,759) to major downsizing. The odds of purchasing prescription antidepressants for exposed increased more than for nonexposed, mainly peridownsizing (1 year before to 1 year after), and postdownsizing (1 year after to 2 years after) for survivors (odds ratio 1.24 vs. 1.14 peridownsizing and 1.12 vs. 1.00 postdownsizing) and those changing workplace (odds ratio 1.22 vs. 1.14 peridownsizing and 1.10 vs. 1.00 postdownsizing) with no previous sickness absence or disability pension (≥7% more than unexposed peri- and postdownsizing). This large-scale study indicates that downsizing is associated with a slight increase in the odds of purchasing prescription antidepressants among people without previous sickness absence or disability pension.

Self-reported indications for antidepressant use in a population-based cohort of middle-aged and elderly

Background Population-based studies investigating indications for antidepressant prescribing mostly rely on diagnoses from general practitioners. However, diagnostic codes might be incomplete and drugs may be prescribed ‘off-label’ for indications not investigated in clinical trials. Objective We aimed to study indications for antidepressant use based on self-report. Also, we studied the presence of depressive symptoms associated with the self-reported indications. Setting Our study population of antidepressant users was selected based on interview data between 1997 and 2013 from the prospective population-based Rotterdam Study cohort (age >45 years). Method Antidepressant use, self-reported indication for use, and presence of depressive symptoms (Center for Epidemiological Studies Depression Scale) were based on interview. Self-reported indications were categorized by the researchers into officially approved, clinically-accepted and commonly mentioned off-label indications. Main outcome measures A score of 16 and higher on the Center for Epidemiological Studies Depression Scale was considered as indicator for clinically-relevant depressive symptoms. Results The majority of 914 antidepressant users reported ‘depression’ (52.4 %) as indication for treatment. Furthermore, anxiety, stress and sleep disorders were reported in selective serotonin reuptake inhibitor and other antidepressant users (ranging from 5.9 to 13.3 %). The indication ‘pain’ was commonly mentioned by tricyclic antidepressant users (19.0 %). Indications were statistically significantly associated with higher depressive symptom scores when compared to non-users (n = 10,979). Conclusions Depression was the main indication for antidepressant treatment. However, our findings suggest that antidepressants are also used for off-label indications, subthreshold disorders and complex situations, which were all associated with clinically-relevant depressive symptoms in the middle-aged and elderly population.

Association between depressive symptoms and age, sex, loneliness and treatment among older people in Sweden

OBJECTIVES

The objective of this study was to examine the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex among older people (65-80 years) and to investigate to what extent those who report depressive symptoms had visited a health care professional and/or used antidepressant medication.

METHOD

A cross-sectional study was conducted in a Swedish sample randomized from the total population in the age group 65-80 years (n = 6659). Chi square tests and logistic regression analyses were conducted.

RESULTS

The data showed that 9.8% (n = 653) reported depressive symptoms and 27.5% reported feelings of loneliness. More men than women reported depressive symptoms, and the largest proportion was found among men in the age group 75-80 years. An association between the odds to have a depressive disorder and loneliness was found which, however, decreased with increasing age. Of those with depressive symptoms a low proportion had visited a psychologist (2.9%) or a welfare officer (4.2%), and one in four reported that they use antidepressant medication. Of those who reported depressive symptoms, 29% considered that they had needed medical care during the last three months but had refrained from seeking, and the most common reason for that was negative experience from previous visits.

CONCLUSION

Contrary to findings in most of the studies, depressive symptoms were not more prevalent among women. The result highlights the importance of detecting depressive symptoms and loneliness in older people and to offer adequate treatment in order to increase their well-being.

Comparison of tolerance of venlafaxine, paroxetine and amitriptyline in depression therapy

Introduction:

There are no controlled studies dedicated to research of side effects of antidepressants. It is a well known fact that antidepressants reciprocally differ according to their type, intensity and frequency of appearance of certain side effects. For example, cardiovascular and anticholinergic effects are essential feature of the tricyclics whereas gastrointestinal and sexual side effects are registered during the use of selective serotonin reuptake inhibitors. Interruptions of therapy or irregular use of drugs because of the appearance of side effects are not rare. Serious side effects of drugs are the fourth cause of death in the USA.

Aim:

The aim of this study is the evaluation of appearance of side effects comparing three different groups of antidepressants: venlafaxine, amitriptyline and paroxetine.

Material and methods:

The study included 90 in-patients as well as outpatients of both sexes aged 18-65 who were treated for major depressive disorder at Psychiatric Clinic in Banjaluka. 30 patients were treated with amitriptyline 75-250 mg, 30 patients were treated with paroxetine 20-40 mg and 30 patients were treated with venlafaxine 75-300 mg. The selection of patients was done on the basis of diagnosis of major depressive disorder.

Results:

Most patients did not have serious side effects. The study confirmed high efficiency of the mentioned drugs as well as the fact that paroxetine causes a bit more side effects in comparison with two other antidepressants.

The Symptom Checklist-core depression (SCL-CD6) scale: Psychometric properties of a brief six item scale for the assessment of depression

Aims: Major depressive disorders are common, with substantial impact on individuals/society. Brief scales for depression severity, based on a small number of characteristics all of which are necessary for diagnosis, have been recommended in self-reported versions for clinical work or research when aiming to quickly and accurately measure depression. We have examined psychometric properties of a brief 6-item version of the Symptom Checklist (SCL), the Symptom Checklist core depression scale (SCL-CD6) and aimed to identify a cut-point for epidemiological research. Methods: The psychometric evaluation of the SCL-CD6 was mainly performed by a Mokken analysis of unidimensionality in a random sample of 1476 residents in the Stockholm County, aged 18–64 years. The standardization of SCL-CD6 was based on ROC analysis, using the Major Depression Inventory as index of validity. Predictive validity was subsequently assessed using register data on hospital admissions and purchases of prescribed medications linked to a sample of 5985 participants in the Swedish Longitudinal Occupational Survey of Health (SLOSH). Results: The SCL-CD6 obtained a coefficient of homogeneity of 0.70 by Mokken analysis, which indicates high unidimensionality and a meaningful dimensional measure of depression severity. By ROC we identified a score of 17 or higher (total range 0–24) as the best cut-point for major depression (sensitivity 0.68, specificity 0.98) which predicted subsequent purchases of antidepressants as well as hospitalisations with a depressive episode. Conclusions: The SCL-CD6 was found a valid depression scale with higher unidimensionality than longer epidemiological instruments and thus particularly suitable for assessment in larger population surveys.

Clinical cues for detection of people with undiscovered depression in primary health care: a case-control study

AIM

To identify clinical cues indicative of depression in medical records of cases in primary care with undetected depression.

BACKGROUND

Depressive disorders are common; the lifetime risk for men and women is 27% and 45%, respectively. Despite effective treatment methods such as antidepressants and cognitive behavioural therapy, depression often remains undiscovered in primary care, with great implications both on the individual and societal level.

METHODS

Clinical cues indicating depression were sought in medical records the year before an opportunistic screening for depression in primary care. In a previous study of 221 patients in the waiting room of a primary care centre during 10 randomly selected days, 45 (20%) showed signs of depression (MADRS-S ⩾ 12) and 60% of these were verified as having depressive disorders (Prime-MD). These 45 patients constitute the cases in the present study. Age- and gender-matched controls were selected among those who scored below the chosen cut-off level.

FINDINGS

Seventeen (38%) of the 45 cases compared with eight (18%) of the 45 controls had one or more cues [odds ratio (OR) 2.81; 95% confidence interval (CI): 1.06-7.43]. Sleep disturbance showed the greatest difference between cases and controls (OR 4.53; 95% CI: 1.17-17.55). A significant relationship was found between severity of depression, frequency of cues and lower functional level. Cues were twice as common in patients with undetected depression and their functional level was lower. A two-stage procedure, screening and a structured diagnostic interview, is recommended when sleep disturbances and lowered function are present.

Antidepressant use and associations with psychosocial work characteristics. A comparative study of Swedish and Danish gainfully employed

BACKGROUND

Although depression is common, prevalence estimates of antidepressant use among the workforce and undisputed evidence relating psychosocial work characteristics to depression is scarce. This study cross-sectionally assesses the prevalence of antidepressant use among employed in Sweden and Denmark and prospectively examines associations between work characteristics and antidepressant use.

METHODS

Data on work demands, influence and learning possibilities was collected 2005-2006 from two representative samples of employed aged 20-59 years from Sweden (n=4351) and Denmark (n=8064) and linked to purchases of antidepressants through national prescription drug registries. Standardized 12-month prevalences were calculated. Cox regressions on work characteristics and incident use were performed separately and estimates pooled.

RESULTS

Employed Swedish residents had higher standardized prevalence than Danish, 6.0% compared to 5.0%. Working fast and conflicting demands were associated with incident use when estimates were pooled, but adjustment for baseline health attenuated these estimates. Emotionally disturbing situations were related to any incident use, and more strongly to use >179 defined daily dosages/year, even after adjustment for various covariates.

LIMITATIONS

Statistics based on national prescription drug registries are influenced by, e.g., treatment seeking behaviours and other reasons for prescription than depression. Selective drop-out may also affect prevalence estimates.

CONCLUSIONS

The study indicates that use of antidepressants among the workforce is relatively high and that employed Swedish residents had higher prevalence of antidepressant use than Danish. Relationships between work characteristics and antidepressant use were, however, similar with emotional demands showing the strongest association, indicating that particular groups of employees may be at increased risk.

Prevalence of depressive symptoms and associated factors in elderly primary care patients: a descriptive study

BACKGROUND

Depressive symptoms are common in older adults. A majority will be seen in primary care. The aim was to study the prevalence of and to explore factors associated with depressive symptoms in elderly primary care patients.

METHOD

In consecutive patients aged 60 years and older attending a Swedish primary care center between February and December of 2003, depressive symptoms were identified as ≥ 13 points on the Montgomery-Asberg Depression Rating Scale-Self-Rated version (MADRS-S). Somatic symptoms measured according to PRIME-MD, age, socioeconomic status, gender, somatic diagnoses, and medication were analyzed in relation to presence of depressive symptoms.

RESULTS

Forty-six of 302 patients (15%) rated themselves in the depressed range. There were no differences between depressed and nondepressed patients concerning socioeconomic status, other illnesses, or medication except for use of sedatives/hypnotics being more common (OR = 2.7, 95% CI = 1.3 to 5.6) in depressed patients. Patients in the group scoring ≥ 13 on the MADRS-S were more likely to have become widowed during the last year (OR = 6.0, 95% CI = 1.7 to 20.8) or to have indicated significant life events (OR = 4.3, 95% CI = 2.0 to 9.0), but were less likely to report having leisure time activities (OR = 0.2, 95% CI = 0.08 to 0.41) or perception of good health (OR = 0.1, 95% CI = 0.05 to 0.3). Patients being treated for depression did not have increased depression scores (OR = 1.4, 95% CI = 0.66 to 3.1).

CONCLUSION

In a group of unselected primary care elderly patients, the prevalence of depressive symptoms was high. Use of sedatives/hypnotics was remarkably common in patients with depressive symptoms. Patients with ongoing treatment of depression did not have increased depression scores, indicating the good prognosis for treated depression in the elderly.

Recognition and subsequent treatment of patients with sub-threshold symptoms of depression in primary care

BACKGROUND

Non-psychiatric physicians are better at correctly ruling out depressive disorders than appropriately recognising them. However, given large numbers of non-depressed patients, a small percentage of false positives equates to a greater number of patients than the number of depressed patients that GPs fail to detect. Concern thus arises that substantial numbers of patients with falsely identified depression may receive inappropriate interventions.

METHODS

Unselected GP consulters were screened with the Hospital Anxiety and Depression Scale (HADS). GPs' perceptions of depression were independently rated on an ICD-10 scale. Case records were reviewed. Analysis related to participants with HADS-D<8. Data were assessed of 660 participants with sub-threshold symptoms. Factors were assessed according to GP ratings.

RESULTS

GP perceived depression in false positive cases were more likely at index visit, to have a mental health presenting problem (OR=6.74 (95% CI=3.21, 14.16); receive antidepressant prescriptions (OR 3.79 (95% CI=1.69, 8.49) and have greater severity of HADS-D score (OR 1.18 (95% CI=1.01, 1.38). Subthreshold cases that GPs identified as depressed, more often had a recording, over subsequent six months, of: depressive symptoms (16 (35%) versus 26 (7%), p<0.001); antidepressant prescriptions (11 (24%) versus 25 (7%), p=0.001); and Community Mental Health Team referrals (4 (9%) versus 1 (<1%), p=0.001). They also consulted GPs more frequently than those not identified (median=5 (IQR 2.8, 6.3) versus median=3 (IQR=2, 5), p=0.004 over six months.

LIMITATIONS

The HADS is not a diagnostic tool.

CONCLUSIONS

GPs' diagnoses of depressive disorder in patients with sub-threshold symptoms were appropriate. Interventions offered to this group were consistent with documented previous histories.

Psychotropic drug use among college students: patterns of use, misuse, and medical monitoring

OBJECTIVE

To assess whether college students who use psychotropic drugs are (1) aware of potential side effects, (2) appropriately monitored by prescribing physicians, and (3) taking medications as prescribed.

PARTICIPANTS

Fifty-five college students, currently taking psychotropic medications, were recruited between Summer 2008 and Fall 2009.

METHODS

Participants were given interviews assessing (1) interactions with prescribing physicians, (2) patterns of psychotropic drug use, and (3) Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) substance use disorders.

RESULTS

Twenty-five percent of participants did not remember being assessed for suicidal ideation. A large number of participants took their medications in different quantities or frequencies than prescribed and 35% of participants met DSM criteria for substance dependence.

CONCLUSIONS

Many students are misusing psychotropic medications and this misuse is not being communicated with prescribing physicians.

Antidepressant medication prevents suicide in depression

OBJECTIVE

Ecological studies have demonstrated a substantial decrease in suicide in parallel with an increasing use of antidepressants. To investigate on the individual level the hypothesis that antidepressant medication was a causal factor.

METHOD

Data on the toxicological detection of antidepressants in 18 922 suicides in Sweden 1992-2003 were linked to registers of psychiatric hospitalization as well as registers with sociodemographic data.

RESULTS

The probability for the toxicological detection of an antidepressant was lowest in the non-suicide controls, higher in suicides, and even higher in suicides that had been psychiatric in-patients but excluding those who had been in-patients for the treatment of depression.

CONCLUSION

The finding that in-patient care for depression did not increase the probability of the detection of antidepressants in suicides is difficult to explain other than by the assumption that a substantial number of depressed individuals were saved from suicide by postdischarge treatment with antidepressant medication.

Antidepressant utilization patterns and mortality in Swedish men and women aged 20-34 years

PURPOSE

To compare antidepressant utilization patterns and mortality in relation to antidepressant use in men and women aged 20-34 years.

METHODS

We used data from the Swedish Prescribed Drug Register to identify adults aged 20-34 years who purchased at least one antidepressant in 2006. Information on death and migration was obtained from the Total Population Register by record linkage. One-year prevalence and proportion of new users, amount of purchased antidepressants, concurrent use of other antidepressants, mood stabilizers and antipsychotics and mortality were assessed.

RESULTS

The one-year prevalence of antidepressant use was 5.6% among all Swedes aged 20-34 years (n = 94,239) and was higher among women than men (7.2 vs. 4.0%, p < 0.001). Selective serotonin reuptake inhibitors were the most dominant class of antidepressants at baseline and were more common among women than men (78.7 vs. 71.7%, p < 0.001). Of the new users, 22.3% filled only one prescription during the study period, men more often than women (24.1 vs. 21.4%, p < 0.001). The mortality rate was higher in men than in women (24 vs. 14 per 10,000, p = 0.009). Concurrent use of mood stabilizers (48 vs. 16 per 10,000, p < 0.001) and antipsychotics (50 vs. 14 per 10,000, p < 0.001) was associated with increased mortality in men and women.

CONCLUSIONS

Almost twice as many Swedish women than men aged 20-34 years purchased antidepressants in 2006. Differences in utilization patterns between sexes were rather small. Discontinuation rates were high, indicating that health care providers need to acquire an increased awareness on attitudes to treatment. In both sexes, mortality rates were elevated among those concurrently using mood stabilizers and antipsychotics, which needs further investigation.

Appropriateness of antidepressant prescribing: an observational study in a Scottish primary-care setting

BACKGROUND

Since the 1990s, Scottish community-based antidepressant prescribing has increased substantially.

AIM

To assess whether GPs prescribe antidepressants appropriately.

DESIGN OF STUDY

Observational study of adults (aged >/=16 years) screened with the Hospital Anxiety and Depression Scale (HADS) attending a GP.

SETTING

Four practices in Grampian, Scotland.

METHOD

Patients (n = 898) completed the HADS, and GPs independently estimated depression status. Notes were scrutinised for evidence of antidepressant use, and the appropriateness of prescribing was assessed.

RESULTS

A total of 237 (26%) participants had HADS scores indicating 'possible' (15%) or 'probable' (11%) depression. The proportion of participants rated as depressed by their GP differed significantly by HADS depression subscale scores. Odds ratio for 'possible' versus 'no' depression was 3.54 (95% confidence interval [CI] = 2.17 to 5.76, P<0.001); and for 'probable' versus 'possible' depression was 3.59 (95% CI = 2.06 to 6.26, P<0.001). Similarly, the proportion of participants receiving antidepressants differed significantly by HADS score. Odds ratio for 'possible' versus 'no' depression was 2.79 (95% CI = 1.70 to 4.58, P<0.001); and for 'probable' versus 'possible' was 2.12 (95% CI = 1.21 to 3.70, P = 0.009). In 101 participants with 'probable' depression, GPs recognised 53 (52%) participants as having a clinically significant depression. Inappropriate initiation of antidepressant treatment occurred very infrequently. Prescribing to participants who were not symptomatic was accounted for by the treatment of pain, anxiety, or relapse prevention, and for ongoing treatment of previously identified depression.

CONCLUSION

There was little evidence of prescribing without relevant indication. Around half of patients with significant symptoms were not identified by their GP as suffering from a depressive disorder: this varied inversely with severity ratings. Rather than prescribing indiscriminately (as has been widely assumed), it is likely that GPs are initiating antidepressant treatment conservatively.

Decrease in suicide among the individuals treated with antidepressants: a controlled study of antidepressants in suicide, Sweden 1995-2005

OBJECTIVE

Ecological studies have demonstrated a substantial decrease in suicide in parallel with an increase in the use of antidepressants. Causality cannot, however, be inferred from such studies. The aim of this study was to test on the individual level the hypothesis that treatment with antidepressant medication has been a substantially contributing cause of the decrease in suicide.

METHOD

Time trends in the detection of antidepressants and five 'control medications' in the forensic toxicological screening of 16 937 suicides and 33 426 controls in Sweden 1995-2005.

RESULTS

The expected number of antidepressant-positive suicides in 2005 was 409 if the hypothesis was true and 603 if it was false. The observed number in 2005 was 420. The control medications were detected to the extent that was expected if not preventing suicide.

CONCLUSION

The observed trend in the number of suicides with antidepressants was well predicted by the hypothesis that the increased use of antidepressants has been a substantially contributing cause of the decrease in suicide.

Antidepressant use and suicide prevention: a prescription database study in the region Friuli Venezia Giulia, Italy

OBJECTIVE

To investigate the possible impact of the increased use of antidepressants on suicide rates in the Italian region of Friuli Venezia Giulia (FVG).

METHOD

Individual-based data on antidepressants in FVG from 1997 to 2006 were obtained from the regional prescription database, and linked to data on suicide for the same period obtained from the regional health information system. Age and sex were considered.

RESULTS

The number of users of antidepressants increased almost fivefold during the study period. Selective serotonin reuptake inhibitors accounted for 71% of the individual users in 2006. The number of defined daily doses (DDD) per patient increased almost sevenfold. In parallel, the suicide rate decreased by one-third in men as well as in women, and in subjects under and over the age of 60 years.

CONCLUSION

Suicide rates in FVG have declined in agreement with the hypothesis that the use of antidepressants may prevent suicide.

Antidepressant utilisation patterns and determinants of short-term and non-psychiatric use in the Finnish general adult population

BACKGROUND

The aim was to study utilisation patterns and determinants of antidepressant use in the general population >30 years, especially short-term use or use not related to known psychiatric morbidity.

METHODS

Participants from a cross-sectional population-based Finnish Health 2000 Study (2000--2001) were linked with the National Prescription Register and National Care Register for Health Care. Within a representative sample (N=7112) of the adult population (>30 years), 12-month DSM-IV depressive, anxiety, and alcohol use disorders were assessed with the M-CIDI. Utilisation patterns of antidepressants were categorised to short-term, intermittent and continuous use. Factors predicting short-term use or use not related to known psychiatric morbidity were investigated.

RESULTS

Of Finnish adults 7.1% had used antidepressants in 2000, of which two-thirds reported a physician-diagnosed mental disorder; a third (35%) had major depressive or anxiety disorder during the previous 12 months. In terms of utilisation pattern, 43% were long-term users, 32% intermittent users and 26% short-term users. Short-term use was related to care by a general practitioner and having no known mental disorder. A quarter of all users had no known psychiatric morbidity. This type of user was most common among the older age groups, and inversely related to being single, on disability pension and using mental health services.

LIMITATIONS

Not all psychiatric indications for antidepressant use could be explored.

CONCLUSIONS

Depression remains the main indication for antidepressant use. About a quarter of users had no known psychiatric indication and the indication remained unclear. Short-term and non-psychiatric use are more commonly prescribed for the elderly.