Antidepressants are medications that are prescribed to treat depression and other psychiatric diseases. In children and adolescents, antidepressant use has been linked to an increased risk of suicide in some studies, leading to a decrease in antidepressant prescriptions. However, antidepressant prescription in children and adolescents rose again for close to a decade from 2005 to 2014. The trends in prescriptions since 2015, however, are unknown. Several studies have also shown that prescription of antidepressants with other medications used to treat psychiatric diseases (called psychotropic drugs) has also increased in the last decade but no recent study has been done in the UK. Given the potential side effects associated with these drugs, it is important to monitor the use of these medications over time. Therefore, our study will describe how prescriptions of antidepressants in children and adolescents aged 5 to 17 years have changed between 2000 and 2018 in the UK. We will also assess how frequently antidepressants are prescribed with other psychotropic medications. Finally, we will assess whether antidepressant prescriptions and coprescription with other psychotropic medications vary with age or between girls and boys. These findings will inform physicians and public health decision makers on the use of these medications over time in children and adolescents in the UK.
In the UK, antidepressant prescriptions in children and adolescents increased in the early 2000s, followed by a brief decline from 2002 to 2005 as the Medicines and Healthcare Products Regulatory Agency issued warnings on the risk of suicide from these medications. In the following decade from 2005 to 2014, the rate of antidepressant prescriptions steadily rose again, approaching the prescriptions rates observed in 2002. The trends in prescriptions since 2015, however, are unknown. Another evolving pattern is the co-prescription of antidepressants with other psychotropic medications in this population. Several studies have shown that paediatric coprescription of antidepressants with other psychotropic medications has increased in Western countries but no recent study has been done in the UK. This trend carries important clinical and policy implications, as nascent evidence suggests that selective serotonin reuptake inhibitors (SSRIs), the most frequently prescribed antidepressant class in children and adolescents, independently raises the risk of incident type 2 diabetes and that concomitant use of atypical antipsychotics carry an additive risk of incident type 2 diabetes in this population. Thus, we will conduct a retrospective cohort to describe trends in prescriptions of antidepressants over time and coprescription with other psychotropic medications in children and adolescents in UK primary care between 2000 and 2018. The cohort will involve all patients between the age of 5 and 17 who are registered in CPRD during the study period. Analysis will include incident and prevalent rates for both antidepressant prescriptions alone and coprescription with other psychotropic medications. Rates will be stratified by age, sex, medication class, socioeconomic status and geographic region. We will also describe the most frequent coprescription combinations each year. Finally, we will compare patient characteristics in 2008 and 2018 to investigate changes in patient profile in the last decade.
First prescription of antidepressants
Concomitant prescription of antidepressants with other psychotropic medications
Baseline characteristics of patients newly prescribed antidepressants : age, sex, body mass index, psychiatric diseases, other comorbidities and measures of health utilization
Samy Suissa - Chief Investigator - Sir Mortimer B Davis Jewish General Hospital
Christel Renoux - Corresponding Applicant - McGill University
Dai Cao - Collaborator - McGill University
Emma Fergusson - Collaborator - Oxford University Hospitals
Hui Yin - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Jonathan Michaud - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Lara Fraga - Collaborator - Universidade Nove de Julho ( UNINOVE )
Laurent Azoulay - Collaborator - McGill University
Soham Rej - Collaborator - McGill University
Sophie Dell'Aniello - Collaborator - McGill University
Guoyuan Liu - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Practice Level Index of Multiple Deprivation