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Relationship between antidepressant and anxiolytic/hypnotic prescribing: a mixed-methods study. 2008

Jill Morrison, and Mary-Jane Anderson, and Sara Mac Donald, and Margaret Maxwell, and Rosalia Munoz-Arroyo, and Andrew Power, and Michael Smith, and Matthew Sutton, and Philip Wilson
Section of General Practice, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow, UK. j.morrison@clinmed.gla.ac.uk

BACKGROUND Antidepressant prescribing has dramatically increased in Scotland, and the cause is unknown. OBJECTIVE To investigate if the increase in antidepressant prescribing coincided with a reduction in prescribing of anxiolytics and hypnotics; to investigate this relationship at practice level; and to explore whether general practitioners (GPs) explain the increase by their increased use for anxiety. METHODS METHODS analysis of routine prescribing data and interviews with GPs. METHODS Scottish general practices. METHODS 942 practices included in the analysis. Sixty-three GPs in 30 practices completed interviews. METHODS Quantity of antidepressants, anxiolytics, and hypnotics prescribed. Relationship at practice level between anxiolytic/hypnotic and antidepressant prescribing. Spontaneous comments by GPs about prescribing antidepressants for anxiety. RESULTS Antidepressant prescribing increased from 28.9 million defined daily doses (DDDs) in 1992/3 to 128.3 million in 2004/5. Anxiolytic/hypnotic prescribing fell from 64.2 million to 55.1 million DDDs. There was a weak, positive correlation between levels of antidepressant and anxiolytic/hypnotic prescribing (+0.084, p=0.010). GPs treated anxiety with antidepressants, although many described an overlap between anxiety and depression. Some spontaneously identified a relationship with benzodiazepine prescribing when asked to explain the increase in antidepressant prescribing. CONCLUSIONS A small part of the increase in antidepressant prescribing is due to substitution for benzodiazepines to treat anxiety.

UI MeSH Term Description Entries
D006993 Hypnotics and Sedatives Drugs used to induce drowsiness or sleep or to reduce psychological excitement or anxiety. Hypnotic,Sedative,Sedative and Hypnotic,Sedatives,Hypnotic Effect,Hypnotic Effects,Hypnotics,Sedative Effect,Sedative Effects,Sedatives and Hypnotics,Effect, Hypnotic,Effect, Sedative,Effects, Hypnotic,Effects, Sedative,Hypnotic and Sedative
D008297 Male Males
D010818 Practice Patterns, Physicians' Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided. Clinical Practice Patterns,Physician's Practice Patterns,Clinical Practice Pattern,Pattern, Clinical Practice,Patterns, Clinical Practice,Practice Pattern, Clinical,Practice Patterns, Clinical,Practice Patterns, Physician's,Prescribing Patterns, Physician,Physician Practice Patterns,Physician Prescribing Pattern,Physician Prescribing Patterns,Physician's Practice Pattern,Physicians' Practice Pattern,Physicians' Practice Patterns,Practice Pattern, Physician's,Practice Pattern, Physicians',Practice Patterns, Physician,Prescribing Pattern, Physician
D003625 Data Collection Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. Data Collection Methods,Dual Data Collection,Collection Method, Data,Collection Methods, Data,Collection, Data,Collection, Dual Data,Data Collection Method,Method, Data Collection,Methods, Data Collection
D003863 Depression Depressive states usually of moderate intensity in contrast with MAJOR DEPRESSIVE DISORDER present in neurotic and psychotic disorders. Depressive Symptoms,Emotional Depression,Depression, Emotional,Depressive Symptom,Symptom, Depressive
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000928 Antidepressive Agents Mood-stimulating drugs used primarily in the treatment of affective disorders and related conditions. Several MONOAMINE OXIDASE INHIBITORS are useful as antidepressants apparently as a long-term consequence of their modulation of catecholamine levels. The tricyclic compounds useful as antidepressive agents (ANTIDEPRESSIVE AGENTS, TRICYCLIC) also appear to act through brain catecholamine systems. A third group (ANTIDEPRESSIVE AGENTS, SECOND-GENERATION) is a diverse group of drugs including some that act specifically on serotonergic systems. Antidepressant,Antidepressant Drug,Antidepressant Medication,Antidepressants,Antidepressive Agent,Thymoanaleptic,Thymoanaleptics,Thymoleptic,Thymoleptics,Antidepressant Drugs,Agent, Antidepressive,Drug, Antidepressant,Medication, Antidepressant
D001008 Anxiety Disorders Persistent and disabling ANXIETY. Anxiety Neuroses,Anxiety States, Neurotic,Neuroses, Anxiety,Anxiety Disorder,Anxiety State, Neurotic,Disorder, Anxiety,Disorders, Anxiety,Neurotic Anxiety State,Neurotic Anxiety States,State, Neurotic Anxiety,States, Neurotic Anxiety
D001569 Benzodiazepines A group of two-ring heterocyclic compounds consisting of a benzene ring fused to a diazepine ring. Benzodiazepine,Benzodiazepine Compounds

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