Skip to main content
SpringerLink
Log in

Patterns of Antidepressant Use in Italy: Therapy Duration, Adherence and Switching

  • Original Research Article
  • Published:
Clinical Drug Investigation Aims and scope Submit manuscript

Abstract

Aim

This study aimed to describe the prescription pattern of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) in an Italian setting, focusing on therapy duration, switching and adherence.

Method

Historic cohort study, based on administrative databases of three Italian local health-units, was conducted. Patients with a prescription of antidepressants (ADs) in 2009 were enrolled and grouped into: (1) naïve, (2) already in treatment with the same drug and (3) already in treatment with a different drug. Therapy duration, switching and adherence [as medication possession ratio-(MPR)] were evaluated. A logistic regression model was performed to identify predictors of adherence.

Results

There were 88,755 subjects recruited: 37 % naïve, 58 % already in treatment with the same drug and 4 % with different drug. A treatment duration of ≤3 months was found in 41 % of naïve patients, whereas the majority of patients already in treatment had a duration of ≥6 months. Switches occurred in 0.7 % of the whole cohort and mostly occurred between two different SSRIs. The 63 % of naïve patients had a low adherence (MPR < 60 %), whereas a good adherence (MPR ≥ 80 %) was found in 58 % of patients already in treatment with the same drug and in 39 % of those already in treatment with different drug. Predictors of adherence were: female gender, increasing comorbidity and pain absence. All ADs, except for fluoxetine and venlafaxine, showed a better adherence than paroxetine.

Conclusion

Notwithstanding the difficulty to associate the AD prescription to the specific diagnosis of depression, this study highlighted a short duration and a low adherence of AD therapies, especially at the initiation of treatment. Physicians should carefully balance the need to prescribe these drugs, considering the great likelihood of a short duration of treatment and a very low level of adherence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Gusmao R, Quintao S, McDaid D, et al. Antidepressant utilization and suicide in Europe: an ecological multi-national study. PLoS One. 2013;8:e66455. doi:10.1371/journal.pone.0066455.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Fernandez A, Pinto-Meza A, Bellon JA, et al. Is major depression adequately diagnosed and treated by general practitioners? Results from an epidemiological study. Gen Hosp Psychiatry. 2010;32:201–9.

    Article  PubMed  Google Scholar 

  3. MacGillivray S, Arroll B, Hatcher S, et al. Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. BMJ. 2003;326:1014.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Mercier A, Auger-Aubin I, Lebeau JP, et al. Evidence of prescription of antidepressants for non-psychiatric conditions in primary care: an analysis of guidelines and systematic reviews. BMC Fam Pract. 2013;14:55. doi:10.1186/1471-2296-14-55.:55-14.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Alonso J, Angermeyer MC, Bernert S, et al. Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 2004;420:55–64.

    PubMed  Google Scholar 

  6. Sorveglianza Passi. Sintomi depressivi nella popolazione adulta: prevalenze e caratteristiche socio-demografiche (Dati nazionali 2012). 2014. http://www.epicentro.iss.it/passi/rapporto2012/depressione.asp. Accessed 7 July 2014.

  7. Gruppo di lavoro Osmed. L’uso dei farmaci in Italia—Rapporto OsMed 2013. 2014. http://www.agenziafarmaco.gov.it/sites/default/files/Rapporto_OsMed_2013.pdf. Accessed 24 June 2015.

  8. Sansone RA, Sansone LA. Antidepressant adherence: are patients taking their medications? Innov Clin Neurosci. 2012;9:41–6.

    PubMed Central  PubMed  Google Scholar 

  9. NICE—National Institute for health and Clinical Excellence. NICE guidelines [CG90]: depression in adults: the treatment and management of depression in adults. 2009. http://www.nice.org.uk/Guidance/CG90. Accessed 7 July 2014.

  10. WHO—World Health Organization. Duration of antidepressant treatment. 2012. http://www.who.int/mental_health/mhgap/evidence/depression/q2/en/. Accessed 7 July 2014.

  11. Lee MS, Lee HY, Kang SG, et al. Variables influencing antidepressant medication adherence for treating outpatients with depressive disorders. J Affect Disord. 2010;123:216–21.

    Article  CAS  PubMed  Google Scholar 

  12. Goethe JW, Woolley SB, Cardoni AA, et al. Selective serotonin reuptake inhibitor discontinuation: side effects and other factors that influence medication adherence. J Clin Psychopharmacol. 2007;27:451–8.

    Article  PubMed  Google Scholar 

  13. Cianferotti L, Parri S, Gronchi G, et al. Changing patterns of prescription in vitamin D supplementation in adults: analysis of a regional dataset. Osteoporos Int. 2015. doi:10.1007/s00198-015-3187-x.

    Google Scholar 

  14. Charlton RA, Jordan S, Pierini A, et al. Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population-based study in six European regions. BJOG. 2015;122:1010–20.

    Article  CAS  PubMed  Google Scholar 

  15. WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2014. 2014. http://www.whocc.no/atc_ddd_index/. Accessed 19 Dec 2014.

  16. WHO—World Healh Organization. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). 2013. http://www.cdc.gov/nchs/icd/icd9cm.htm. Accessed 19 Dec 2014.

  17. Italian Ministry of Health. Classification of Diagnosis Related Groups version 24. 2009. http://www.salute.gov.it/imgs/C_17_pubblicazioni_1094_allegato.pdf. Accessed 19 Dec 2014.

  18. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  PubMed  Google Scholar 

  19. 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. 2013;69:2095–101.

    Article  PubMed  Google Scholar 

  20. Parabiaghi A, Franchi C, Tettamanti M, et al. Antidepressants utilization among elderly in Lombardy from 2000 to 2007: dispensing trends and appropriateness. Eur J Clin Pharmacol. 2011;67:1077–83.

    Article  CAS  PubMed  Google Scholar 

  21. Trifiro G, Barbui C, Spina E, et al. Antidepressant drugs: prevalence, incidence and indication of use in general practice of Southern Italy during the years 2003–2004. Pharmacoepidemiol Drug Saf. 2007;16:552–9.

    Article  CAS  PubMed  Google Scholar 

  22. Aguglia E, Ravasio R, Simonetti M, et al. Use and treatment modalities for SSRI and SNRI antidepressants in Italy during the period 2003–2009. Curr Med Res Opin. 2012;28:1475–84.

    Article  CAS  PubMed  Google Scholar 

  23. Ferguson JM. SSRI antidepressant medications: adverse effects and tolerability. Prim Care Companion J Clin Psychiatry. 2001;3:22–7.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Kroenke K, Wu J, Bair MJ, et al. Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain. 2011;12:964–73.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Esposito D, Wahl P, Daniel G, et al. 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. 2009;31:644–56.

    Article  CAS  PubMed  Google Scholar 

  26. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009;373:746–58.

    Article  CAS  PubMed  Google Scholar 

  27. Purgato M, Papola D, Gastaldon C, et al. Paroxetine versus other anti-depressive agents for depression. Cochrane Database Syst Rev. 2014;4:CD006531. doi:10.1002/14651858.CD006531.pub2.:CD006531.

    PubMed  Google Scholar 

  28. Carnovale C, Conti V, Perrone V, et al. Paediatric drug use with focus on off-label prescriptions in Lombardy and implications for therapeutic approaches. Eur J Pediatr. 2013;172:1679–85.

    Article  PubMed  Google Scholar 

  29. Kirchmayer U, Di MM, Agabiti N, et al. Effect of evidence-based drug therapy on long-term outcomes in patients discharged after myocardial infarction: a nested case-control study in Italy. Pharmacoepidemiol Drug Saf. 2013;22:649–57.

    Article  PubMed Central  PubMed  Google Scholar 

  30. De BG, Lucisano G, D’Ettorre A, et al. Association of aspirin use with major bleeding in patients with and without diabetes. JAMA. 2012;307:2286–94.

    Google Scholar 

  31. Cheatle MD. Assessing suicide risk in patients with chronic pain and depression. J Fam Pract. 2014;63:S6–11.

    PubMed  Google Scholar 

  32. Salama-Hanna J, Chen G. Patients with chronic pain. Med Clin N Am. 2013;97:1201–15.

    Article  PubMed  Google Scholar 

  33. Gardarsdottir H, Heerdink ER, van Dijk L, et al. Indications for antidepressant drug prescribing in general practice in the Netherlands. J Affect Disord. 2007;98:109–15.

    Article  CAS  PubMed  Google Scholar 

  34. Gardarsdottir H, Egberts AC, van Dijk L, et al. An algorithm to identify antidepressant users with a diagnosis of depression from prescription data. Pharmacoepidemiol Drug Saf. 2009;18:7–15.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Emanuel Raschi (researcher at Department of Medical and Surgical Sciences, University of Bologna) for his comments and editing assistance in the revision of the final manuscript.

Author information

Authors and Affiliations

  1. CliCon Srl, Health, Economics and Outcomes Research, Via Salara, 36, 48100, Ravenna, Italy

    Luca Degli Esposti, Diego Sangiorgi & Stefano Buda

  2. Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Carlo Piccinni

  3. Department of Molecular Medicine, University of Siena, Siena, Italy

    Andrea Fagiolini

Authors
  1. Luca Degli Esposti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlo Piccinni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Diego Sangiorgi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Fagiolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefano Buda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Degli Esposti.

Ethics declarations

Ethical approval

In order to guarantee privacy, patients’ personal information was encrypted and each subject was assigned an anonymous univocal code that allowed to link the searched databases. No patient identifiers were provided to the researchers. For this type of study formal consent is not required. The Ethics Committees of the involved local health units approved the study.

Conflict of interest

LDE, CP, DS and SB declare that they have no conflict of interest. AF provided consultancies and/or speaker and/or participation in advisory boards and/or research grants for Angelini, Astra Zeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Janssen, Lundbeck, Novartis, Otsuka, Pfizer, Roche, Takeda.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Degli Esposti, L., Piccinni, C., Sangiorgi, D. et al. Patterns of Antidepressant Use in Italy: Therapy Duration, Adherence and Switching. Clin Drug Investig 35, 735–742 (2015). https://doi.org/10.1007/s40261-015-0332-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40261-015-0332-4

Keywords

Search

Navigation