Paul A Tiffin
What were the impacts of the Committee on Safety of Medicines warning and publication of the NICE guidelines on trends in child and adolescent antidepressant prescribing in primary care? A population based study
Tiffin, Paul A; Mediavilla, Jose L; Close, Helen; Kasim, Adetayo S; Welsh, Patrick; Paton, Lewis W; Mason, James M
Authors
Jose L Mediavilla
Helen Close
Adetayo S Kasim
Patrick Welsh
Lewis W Paton
James M Mason
Abstract
Objectives To assess the impact of both the Committee on Safety of Medicines (CSM) warning (December 2003) and the National Institute for Health and Care Excellence (NICE) guidance (September 2005) on antidepressant prescription rates in children and adolescents within the UK primary care service. Setting Population based study of primary care antidepressant prescribing using the Clinical Practice Research Datalink (CPRD). Participants Under-18s presenting to primary care with a depressive disorder or related diagnostic code recorded in the CPRD. Primary outcome measure Antidepressant prescription rates per month per 100 000 depressed 4–17 year olds. Results Following the CSM warning, the prior trend towards increased prescribing rates for selective serotonin reuptake inhibitors (SSRIs) in children was significantly reversed (β for change in trend −12.34 (95% CI −18.67 to −6.00, p<0.001)). However, after the publication of the NICE guidelines the prior trend towards increased prescribing resumed for those SSRIs mentioned as potential treatments in the guidance (fluoxetine, citalopram and sertraline) (β for change in trend 11.52 (95% CI 5.32 to 17.73, p<0.001)). Prescribing of other SSRIs and tricyclics remained low. Conclusions Despite a strong emphasis on psychosocial interventions for child and adolescent depression, it may be that the NICE guidelines inadvertently encouraged further antidepressant prescribing, at least for those SSRIs cited. Although the guidelines gave cautions and caveats for the use of antidepressants, practitioners may have interpreted these recommendations as endorsing their use in young people with depression and related conditions. However, more accurate prevalence trend estimates for depression in this age group, and information on the use of psychosocial interventions would be needed to rule out other reasons underlying this increase in prescribing.
Citation
Tiffin, P. A., Mediavilla, J. L., Close, H., Kasim, A. S., Welsh, P., Paton, L. W., & Mason, J. M. (2019). What were the impacts of the Committee on Safety of Medicines warning and publication of the NICE guidelines on trends in child and adolescent antidepressant prescribing in primary care? A population based study. BMJ Open, 9(8), Article e028201. https://doi.org/10.1136/bmjopen-2018-028201
Journal Article Type | Article |
---|---|
Acceptance Date | Jun 19, 2019 |
Online Publication Date | Aug 7, 2019 |
Publication Date | Aug 7, 2019 |
Deposit Date | Aug 21, 2019 |
Publicly Available Date | Aug 21, 2019 |
Journal | BMJ Open |
Electronic ISSN | 2044-6055 |
Publisher | BMJ Publishing Group |
Peer Reviewed | Peer Reviewed |
Volume | 9 |
Issue | 8 |
Article Number | e028201 |
DOI | https://doi.org/10.1136/bmjopen-2018-028201 |
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http://creativecommons.org/licenses/by-nc/4.0/
Copyright Statement
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC.
No commercial re-use. See rights and permissions. Published by BMJ.
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