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What were the impacts of the committee on safety for medicines warning and publication of the NICE Guidelines on trends in child and adolescent antidepressant prescribing in primary care? : a population based study
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Tiffin, Paul Alexander, Mediavilla, José L., Close, Helen, Kasim, Adetayo S., Welsh, Patrick, Paton, Lewis William and Mason, James (2019) What were the impacts of the committee on safety for 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 . e02820. doi:10.1136/bmjopen-2018-028201 ISSN 2044-6055.
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Official URL: http://www.doi.org/10.1136/bmjopen-2018-028201
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.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RJ Pediatrics | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Depression in children -- Research, Antidepressants, Depression in adolescence, Primary care (Medicine) -- Great Britain, Mental Disorders -- drug therapy -- Child, Antidepressants -- Effectiveness -- Great Britain, Psychotropic drugs, Drugs -- Prescribing -- Safety measures | ||||||||
Journal or Publication Title: | BMJ Open | ||||||||
Publisher: | BMJ | ||||||||
ISSN: | 2044-6055 | ||||||||
Official Date: | 2019 | ||||||||
Dates: |
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Volume: | 9 | ||||||||
Article Number: | e02820 | ||||||||
DOI: | 10.1136/bmjopen-2018-028201 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Date of first compliant deposit: | 25 June 2019 | ||||||||
Date of first compliant Open Access: | 1 July 2019 |
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