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Trend in SSRI-SNRI antidepressants prescription over a 6-year period and predictors of poor adherence

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To describe antidepressant (AD) use in the Emilia-Romagna Region (Italy) and to evaluate adherence to treatment with selective serotonin receptor inhibitors or selective noradrenaline receptor inhibitors (SSRI-SNRI).

Methods

Reimbursed prescriptions of AD were retrieved from the Emilia-Romagna Regional Health Authority Database. The overall AD consumption from the 2006–2011 period was expressed in terms of prevalence and amount of use. Adherence to treatment was assessed in a cohort of patients who received SSRI-SNRI, and was followed throughout a 6-month period from the start of each treatment episode. Adherence was considered according to three parameters: duration of treatment ≥ 120 days, prescription coverage ≥ 80 %, and gaps between prescriptions < 3 months. Determinants of non-adherent regimen, including sociodemographic and clinical variables, were identified by multivariate logistic regression by calculating adjusted Odds Ratio (adjOR) and the relevant 95 % confidence interval (95CI).

Results

From 2006 to 2011, the prevalence of use of AD increased by 5 % (from 86 to 90 per 1,000 inhabitants) and the amount of antidepressant consumption increased by 20 % (from 43 to 51 defined daily dose per thousand inhabitants per day [DDD/TID]), with a 14 % rise in the intensity of drug use (from 182 to 208 DDD per patient). Out of 347,615 SSRI-SNRI treatment episodes, only 23.8 % were adherent. Comorbidity (adjOR:0.69; 95CI:0.67–0.72) and recurrence of AD treatment in the previous year (0.91; 0.89–0.92) were associated with better adherence. Moreover, patients treated with duloxetine (0.58; 0.55–0.60), escitalopram (0.64; 0.62–0.66) or sertraline (0.65; 0.64–0.67) showed better adherence in comparison with paroxetine.

Conclusions

Clinical variables resulting in improved adherence seem to identify patients with more severe disorders and who actually need a pharmacological approach, whereas differences in adherence among ADs could in part be caused by channeling and sponsorship bias. Initiatives addressed at improving cooperation between primary care and psychiatrists could decrease AD prescription for cases of sub-threshold or mild depression that easily drop out because of rapid symptom relief or side effects.

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References

  1. Ilyas S, Moncrieff J (2012) Trends in prescriptions and costs of drugs for mental disorders in England, 1998-2010. Br J Psychiatry 200(5):393–398

    Article  PubMed  Google Scholar 

  2. Parabiaghi A, Franchi C, Tettamanti M, Barbato A, D’Avanzo B, Fortino I, Bortolotti A, Merlino L, Nobili A (2011) Antidepressants utilization among elderly in Lombardy from 2000 to 2007: dispensing trends and appropriateness. Eur J Clin Pharmacol 67(10):1077–1083

    Article  PubMed  CAS  Google Scholar 

  3. Mojtabai R, Olfson M (2011) Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Aff (Millwood) 30(8):1434–1442

    Article  Google Scholar 

  4. Arias LH, Lobato CT, Ortega S, Velasco A, Carvajal A, del Pozo JG (2010) Trends in the consumption of antidepressants in Castilla y Leon (Spain). Association between suicide rates and antidepressant drug consumption. Pharmacoepidemiol Drug Saf 19(9):895–900

    Article  PubMed  Google Scholar 

  5. Zahl PH, De LD, Ekeberg O, Hjelmeland H, Dieserud G (2010) The relationship between sales of SSRI, TCA and suicide rates in the Nordic countries. BMC Psychiatry 10:62. doi:10.1186/1471-244X-10-62.:62-10

    PubMed  Google Scholar 

  6. L’uso dei farmaci in Italia - Rapporto Nazionale anno 2011, August, 2012. http://www.agenziafarmaco.gov.it/it/content/luso-dei-farmaci-italia-rapporto-osmed-2011 Accessed April 16, 2013

  7. Kessler RC, Walters EE (1998) Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the National Comorbidity Survey. Depress Anxiety 7(1):3–14

    Article  PubMed  CAS  Google Scholar 

  8. Ormel J, Koeter MW, van den Brink W, van de Willige G (1991) Recognition, management, and course of anxiety and depression in general practice. Arch Gen Psychiatry 48(8):700–706

    Article  PubMed  CAS  Google Scholar 

  9. Ustun TB, Von Korff M (1995) Primary mental health services: access and provision of care. In: Ustun TB, Sartorius N (eds) Mental illness in general health care: an international study. Wiley, Chichester, UK, pp 347–360

  10. Mercier A, Auger-Aubin I, Lebeau JP, Schuers M, Boulet P, Hermil JL, Van RP, Peremans L (2013) Evidence of prescription of antidepressants for non-psychiatric conditions in primary care: an analysis of guidelines and systematic reviews. BMC Fam Pract 14:55. doi:10.1186/1471-2296-14-55.:55-14

    Article  PubMed  Google Scholar 

  11. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT (2008) Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 5(2):e45

    Article  PubMed  Google Scholar 

  12. Barbui C, Cipriani A, Patel V, Ayuso-Mateos JL, van Ommeren M (2011) Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. Br J Psychiatry 198(1):11–16, sup

    Article  PubMed  Google Scholar 

  13. Trifiro G, Tillati S, Spina E, Ferrajolo C, Alacqua M, Aguglia E, Rizzi L, Caputi AP, Cricelli C, Samani F (2013) A nationwide prospective study on prescribing pattern of antidepressant drugs in Italian primary care. Eur J Clin Pharmacol 69(2):227–236

    Article  PubMed  Google Scholar 

  14. Poluzzi E, Motola D, Silvani C, De Ponti F, Vaccheri A, Montanaro N (2004) Prescriptions of antidepressants in primary care in Italy: pattern of use after admission of selective serotonin reuptake inhibitors for reimbursement. Eur J Clin Pharmacol 59(11):825–831

    Article  PubMed  Google Scholar 

  15. Damiani G, Federico B, Silvestrini G, Bianchi CB, Anselmi A, Iodice L, Ronconi A, Navarra P, Da CR, Raschetti R, Ricciardi W (2013) Impact of regional copayment policy on selective serotonin reuptake inhibitor (SSRI) consumption and expenditure in Italy. Eur J Clin Pharmacol 69(4):957–963

    Article  PubMed  Google Scholar 

  16. NICE National Institute for Health and Clinical Excellence (2009) Depression: the treatment and management of depression in adults (update). http://guidance.nice.org.uk/CG90 Accessed February 21, 2013

  17. Keller MB, Boland RJ (1998) Implications of failing to achieve successful long-term maintenance treatment of recurrent unipolar major depression. Biol Psychiatry 44(5):348–360

    Article  PubMed  CAS  Google Scholar 

  18. McLaughlin KA (2011) The public health impact of major depression: a call for interdisciplinary prevention efforts. Prev Sci 12(4):361–371

    Article  PubMed  Google Scholar 

  19. The Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) Index 2013, January 18, 2013. http://www.whocc.no/ Accessed April 16, 2013

  20. Wichniak A, Wierzbicka A, Jernajczyk W (2012) Sleep and antidepressant treatment. Curr Pharm Des 18(36):5802–5817

    Article  PubMed  CAS  Google Scholar 

  21. Fagiolini A, Comandini A, Catena DM, Kasper S (2012) Rediscovering trazodone for the treatment of major depressive disorder. CNS Drugs 26(12):1033–1049

    Article  PubMed  CAS  Google Scholar 

  22. Wettermark B, Vlahovic-Palcevski V, Salvesen Blix H, Rønning M, Vander Stichele R (2008) Drug utilization research. In: Hartzema AG, Tilson HH, Chan KA (eds) Pharmacoepidemiology and therapeutic risk assessment. Harwey Whitney, Cincinnati, USA, pp 159–195

  23. Von KM, Wagner EH, Saunders K (1992) A chronic disease score from automated pharmacy data. J Clin Epidemiol 45(2):197–203

    Article  Google Scholar 

  24. Rosholm JU, Andersen M, Gram LF (2001) Are there differences in the use of selective serotonin reuptake inhibitors and tricyclic antidepressants? A prescription database study. Eur J Clin Pharmacol 56(12):923–929

    Article  PubMed  CAS  Google Scholar 

  25. Health at a Glance 2011- OECD Indicators, November 23, 2011. 10.1787/health_glance-2011-en Accessed April 16, 2013

  26. Aguglia E, Ravasio R, Simonetti M, Pecchioli S, Mazzoleni F (2012) Use and treatment modalities for SSRI and SNRI antidepressants in Italy during the period 2003-2009. Curr Med Res Opin 28(9):1475–1484

    Article  PubMed  CAS  Google Scholar 

  27. Hernandez JF, Mantel-Teeuwisse AK, van Thiel GJ, Belitser SV, Warmerdam J, de Valk V, Raaijmakers JA, Pieters T (2012) A 10-year analysis of the effects of media coverage of regulatory warnings on antidepressant use in The Netherlands and UK. PLoS One 7(9):e45515

    Article  PubMed  CAS  Google Scholar 

  28. Sansone RA, Sansone LA (2012) Antidepressant adherence: are patients taking their medications? Innov Clin Neurosci 9(5–6):41–46

    PubMed  Google Scholar 

  29. Burton C, Anderson N, Wilde K, Simpson CR (2012) Factors associated with duration of new antidepressant treatment: analysis of a large primary care database. Br J Gen Pract 62(595):e104–e112

    Article  PubMed  Google Scholar 

  30. Lu CY, Roughead E (2012) New users of antidepressant medications: first episode duration and predictors of discontinuation. Eur J Clin Pharmacol 68(1):65–71

    Article  PubMed  Google Scholar 

  31. Liu XC, Chen Y, Faries D, Miner C, Swindle R (2009) Impact of comorbidities on antidepressant initiation: duloxetine, venlafaxine, and escitalopram versus other SSRIs. 38th American College of Clinical Pharmacology Annual Meeting

  32. Liu X, Chen Y, Faries DE (2011) Adherence and persistence with branded antidepressants and generic SSRIs among managed care patients with major depressive disorder. Clinicoecon Outcomes Res 3:63–72. doi:10.2147/CEOR.S17846. Epub;%2011 Mar 15.:63–72

  33. Esposito D, Wahl P, Daniel G, Stoto MA, Erder MH, Croghan TW (2009) Results of a retrospective claims database analysis of differences in antidepressant treatment persistence associated with escitalopram and other selective serotonin reuptake inhibitors in the United States. Clin Ther 31(3):644–656

    Article  PubMed  CAS  Google Scholar 

  34. Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H, Tansella M, Barbui C (2009) Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 373(9665):746–758

    Article  PubMed  CAS  Google Scholar 

  35. Lundh A, Sismondo S, Lexchin J, Busuioc OA, Bero L (2012) Industry sponsorship and research outcome. Cochrane Database Syst Rev 12, MR000033. doi:10.1002/14651858.MR000033.pub2.:MR000033

    PubMed  Google Scholar 

  36. Tarricone I, Stivanello E, Ferrari S, Colombini N, Bolla E, Braca M, Giubbarelli C, Costantini C, Cazzamalli S, Mimmi S, Tedesco D, Menchetti M, Rigatelli M, Maso E, Balestrieri M, Vender S, Berardi D (2012) Migrant pathways to community mental health centres in Italy. Int J Soc Psychiatry 58(5):505–511

    Article  PubMed  Google Scholar 

  37. Clancy Z, Keith SW, Rabinowitz C, Ceccarelli M, Gagne JJ, Maio V (2013) Statins and colorectal cancer risk: a longitudinal study. Cancer Causes Control 24(4):777–782

    PubMed  Google Scholar 

  38. Poluzzi E, Piccinni C, Carta P, Puccini A, Lanzoni M, Motola D, Vaccheri A, De Ponti F, Montanaro N (2011) Cardiovascular events in statin recipients: impact of adherence to treatment in a 3-year record linkage study. Eur J Clin Pharmacol 67(4):407–414

    Article  PubMed  Google Scholar 

  39. Berardi D, Menchetti M, Cevenini N, Scaini S, Versari M, De RD (2005) Increased recognition of depression in primary care. Comparison between primary-care physician and ICD-10 diagnosis of depression. Psychother Psychosom 74(4):225–230

    Article  PubMed  Google Scholar 

  40. Rix S, Paykel ES, Lelliott P, Tylee A, Freeling P, Gask L, Hart D (1999) Impact of a national campaign on GP education: an evaluation of the Defeat Depression Campaign. Br J Gen Pract 49(439):99–102

    PubMed  CAS  Google Scholar 

  41. Macdonald S, Maxwell M, Wilson P, Smith M, Whittaker W, Sutton M, Morrison J (2012) A powerful intervention: general practitioners’; use of sickness certification in depression. BMC Fam Pract 13:82. doi:10.1186/1471-2296-13-82.:82-13

    Article  PubMed  Google Scholar 

  42. Bortolotti B, Menchetti M, Bellini F, Montaguti MB, Berardi D (2008) Psychological interventions for major depression in primary care: a meta-analytic review of randomized controlled trials. Gen Hosp Psychiatry 30(4):293–302

    Article  PubMed  Google Scholar 

  43. Tarricone I, Stivanello E, Poggi F, Castorini V, Marseglia MV, Fantini MP, Berardi D (2012) Ethnic variation in the prevalence of depression and anxiety in primary care: a systematic review and meta-analysis. Psychiatry Res 195(3):91–106

    Article  PubMed  Google Scholar 

  44. Neumeyer-Gromen A, Lampert T, Stark K, Kallischnigg G (2004) Disease management programs for depression: a systematic review and meta-analysis of randomized controlled trials. Med Care 42(12):1211–1221

    Article  PubMed  Google Scholar 

  45. Andersson SJ, Troein M, Lindberg G (2005) General practitioners’ conceptions about treatment of depression and factors that may influence their practice in this area. a postal survey. BMC Fam Pract 6(1):21

    Article  PubMed  Google Scholar 

  46. Andersson SJ, Troein M, Lindberg G (2001) Conceptions of depressive disorder and its treatment among 17 Swedish GPs. A qualitative interview study. Fam Pract 18(1):64–70

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The study was supported by funds from the University of Bologna and the Emilia Romagna Health Authority.

Conflict of interest

All authors declare no conflicts of interest with the contents of this manuscripts.

The opinions expressed herein by E.S. and M.C. do not necessarily reflect those of the Emilia Romagna Health Authority.

Author information

Authors and Affiliations

  1. Department of Medical and Surgical Sciences – Pharmacology Unit, University of Bologna, Via Irnerio, 48, 40126, Bologna, BO, Italy

    Elisabetta Poluzzi, Carlo Piccinni & Fabrizio De Ponti

  2. Drug Policy Service, Emilia Romagna Region Health Authority, Bologna, Italy

    Elisa Sangiorgi

  3. Information Service, Emilia Romagna Region Health Authority, Bologna, Italy

    Massimo Clo

  4. Department of Medical and Surgical Sciences - Psychiatric Unit, University of Bologna, Bologna, Italy

    Ilaria Tarricone & Marco Menchetti

Authors
  1. Elisabetta Poluzzi
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  2. Carlo Piccinni
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  3. Elisa Sangiorgi
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  4. Massimo Clo
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  5. Ilaria Tarricone
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  7. Fabrizio De Ponti
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Corresponding author

Correspondence to Fabrizio De Ponti.

Additional information

Previous presentation

Part of the results were presented at the European Drug Utilisation Research Group of International Society of Pharmaco-Epidemiology (EuroDURG/ISPE) meeting in Antwerp (30 November – 3 December 2011).

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Poluzzi, E., Piccinni, C., Sangiorgi, E. et al. Trend in SSRI-SNRI antidepressants prescription over a 6-year period and predictors of poor adherence. Eur J Clin Pharmacol 69, 2095–2101 (2013). https://doi.org/10.1007/s00228-013-1567-8

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  • DOI: https://doi.org/10.1007/s00228-013-1567-8

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