European Journal of Clinical Pharmacology

, Volume 69, Issue 2, pp 227–236 | Cite as

A nationwide prospective study on prescribing pattern of antidepressant drugs in Italian primary care

  • Gianluca Trifirò
  • Silvia Tillati
  • Edoardo Spina
  • Carmen Ferrajolo
  • Marianna Alacqua
  • Eugenio Aguglia
  • Laura Rizzi
  • Achille P. Caputi
  • Claudio Cricelli
  • Fabio Samani
Pharmacoepidemiology and Prescription

Abstract

Purpose

Our purpose was to explore antidepressant drug (AD) prescribing patterns in Italian primary care.

Methods

Overall, 276 Italian general practitioners (GPs) participated in this prospective study, recruiting patients >18 years who started AD therapy during the enrolment period (January 2007 to June 2008). During visits at baseline and 3, 6, and 12 months, data about patients’ characteristics and AD treatments were collected by the GPs. Discontinuation rate among new users of AD classes [i.e., selective serotonin reuptake inhibitors (SSRI); tricyclics (TCAs); other ADs) were compared. Logistic regression analyses were performed to identify predictors of AD discontinuation.

Results

SSRIs were the most frequently prescribed ADs (N = 1,037; 75.3 %), especially paroxetine and escitalopram. SSRIs were more likely to be prescribed because of depressive disorders (80 %), and by GPs (51.1 %) rather than psychiatrists (31.8 %). Overall, 27.5 % (N = 378) of AD users discontinued therapy during the first year, mostly in the first 3 months (N = 242; 17.6 %), whereas 185 (13.4 %) were lost to follow-up. SSRI users showed the highest discontinuation rate (29 %). In patients with depressive disorders, younger age, psychiatrist-based diagnosis, and treatment started by GPs were independent predictors of SSRI discontinuation.

Conclusions

In Italy, ADs—especially SSRIs—are widely prescribed by GPs because of depressive/anxiety disorders. Active monitoring of AD users in general practice might reduce the AD discontinuation rate.

Keywords

General practice Antidepressives Pharmacoepidemiology Italy 

Notes

Acknowledgments

This study was funded by the Italian Drug Agency through a national grant dedicated to pharmacovigilance projects.

Conflict of interest

None

References

  1. 1.
    Haden ACB (2001) The world health report 2001.Mental health: new understanding, new hope. World Health Organization, Geneva, 30.2001Google Scholar
  2. 2.
    Sturm R, Meredith LS, Wells KB (1996) Provider choice and continuity for the treatment of depression. Med Care 34:723–734PubMedCrossRefGoogle Scholar
  3. 3.
    Pomerantz JM, Finkelstein SN, Berndt ER, Poret AW, Walker LE, Alber RC et al (2004) Prescriber intent, off-label usage, and early discontinuation of antidepressants: a retrospective physician survey and data analysis. J Clin Psychiatry 65:395–404PubMedCrossRefGoogle Scholar
  4. 4.
    Isacsson G, Boethius G, Henriksson S, Jones JK, Bergman U (1999) Selective serotonin reuptake inhibitors have broadened the utilisation of antidepressant treatment in accordance with recommendations. Findings from a Swedish prescription database. J Affect Disord 53:15–22PubMedCrossRefGoogle Scholar
  5. 5.
    Kuyken W, Byford S, Byng R, Dalgleish T, Lewis G, Taylor R et al Study protocol for a randomized controlled trial comparing mindfulness-based cognitive therapy with maintenance anti-depressant treatment in the prevention of depressive relapse/recurrence: the PREVENT trial. Trials 11:99Google Scholar
  6. 6.
    Walsh JK (2004) Pharmacologic management of insomnia. J Clin Psychiatry 65(Suppl 16):41–45PubMedGoogle Scholar
  7. 7.
    Zinner NR, Koke SC, Viktrup L (2004) Pharmacotherapy for stress urinary incontinence: present and future options. Drugs 64:1503–1516PubMedCrossRefGoogle Scholar
  8. 8.
    Colombo B, Annovazzi PO, Comi G (2004) Therapy of primary headaches: the role of antidepressants. Neurol Sci 25(Suppl 3):S171–S175PubMedCrossRefGoogle Scholar
  9. 9.
    Maizels M, McCarberg B (2005) Antidepressants and antiepileptic drugs for chronic non-cancer pain. Am Fam Physician 71:483–490PubMedGoogle Scholar
  10. 10.
    Ufer M, Meyer SA, Junge O, Selke G, Volz HP, Hedderich J et al (2007) Patterns and prevalence of antidepressant drug use in the German state of Baden-Wuerttemberg: a prescription-based analysis. Pharmacoepidemiol Drug Saf 16:1153–1160PubMedCrossRefGoogle Scholar
  11. 11.
    Svab V, Subelj M, Vidmar G Prescribing changes in anxiolytics and antidepressants in Slovenia. Psychiatr Danub 23:178–182Google Scholar
  12. 12.
    Demyttenaere K, Bonnewyn A, Bruffaerts R, De Girolamo G, Gasquet I, Kovess V et al (2008) Clinical factors influencing the prescription of antidepressants and benzodiazepines: results from the European study of the epidemiology of mental disorders (ESEMeD). J Affect Disord 110:84–93PubMedCrossRefGoogle Scholar
  13. 13.
    Trifiro G, Barbui C, Spina E, Moretti S, Tari M, Alacqua M et al (2007) Antidepressant drugs: prevalence, incidence and indication of use in general practice of Southern Italy during the years 2003–2004. Pharmacoepidemiol Drug Saf 16:552–559PubMedCrossRefGoogle Scholar
  14. 14.
    Avorn J (2001) Improving drug use in elderly patients: getting to the next level. JAMA 286:2866–2868PubMedCrossRefGoogle Scholar
  15. 15.
    Weissman J, Meyers BS, Ghosh S, Bruce ML (2011) Sociodemographic and clinical factors associated with antidepressant type in a national sample of the home health care elderly. Gen Hosp Psychiatry 33:587–593PubMedCrossRefGoogle Scholar
  16. 16.
    Bauer M, Monz BU, Montejo AL, Quail D, Dantchev N, Demyttenaere K et al (2008) Prescribing patterns of antidepressants in Europe: results from the Factors Influencing Depression Endpoints Research (FINDER) study. Eur Psychiatry 23:66–73PubMedCrossRefGoogle Scholar
  17. 17.
    Zimmerman M, Posternak M, Friedman M, Attiullah N, Baymiller S, Boland R et al (2004) Which factors influence psychiatrists’ selection of antidepressants? Am J Psychiatry 161:1285–1289PubMedCrossRefGoogle Scholar
  18. 18.
    Rich CL, Isacsson G (1997) Suicide and antidepressants in south Alabama: evidence for improved treatment of depression. J Affect Disord 45:135–142PubMedCrossRefGoogle Scholar
  19. 19.
    Percudani M, Barbui C, Fortino I, Petrovich L (2004) Antidepressant drug use in Lombardy, Italy: a population-based study. J Affect Disord 83:169–175PubMedCrossRefGoogle Scholar
  20. 20.
    Poluzzi E, Motola D, Silvani C, De Ponti F, Vaccheri A, Montanaro N (2004) Prescriptions of antidepressants in primary care in Italy: pattern of use after admission of selective serotonin reuptake inhibitors for reimbursement. Eur J Clin Pharmacol 59:825–831PubMedCrossRefGoogle Scholar
  21. 21.
    Guaiana G, Andretta M, Griez E, Biancosino B, Grassi L Sales of antidepressants, suicides and hospital admissions for depression in Veneto Region, Italy, from 2000 to 2005: an ecological study. Ann Gen Psychiatry 10:24Google Scholar
  22. 22.
    Balestrieri M, Carta MG, Leonetti S, Sebastiani G, Starace F, Bellantuono C (2004) Recognition of depression and appropriateness of antidepressant treatment in Italian primary care. Soc Psychiatry Psychiatr Epidemiol 39:171–176PubMedCrossRefGoogle Scholar
  23. 23.
    Castelpietra G, Morsanutto A, Pascolo-Fabrici E, Isacsson G (2008) Antidepressant use and suicide prevention: a prescription database study in the region Friuli Venezia Giulia, Italy. Acta Psychiatr Scand 118:382–388PubMedCrossRefGoogle Scholar
  24. 24.
    Evaluation of prescribing pattern and safety profile of antidepressant and antipsychotic medications in Italian general practiceGoogle Scholar
  25. 25.
    Spina E, Trifiro G, Caraci F Clinically significant drug interactions with newer antidepressants. CNS drugs 26:39–67Google Scholar
  26. 26.
    Kjosavik SR, Hunskaar S, Aarsland D, Ruths S (2011) Initial prescription of antipsychotics and antidepressants in general practice and specialist care in Norway. Acta Psychiatr Scand 123:459–465PubMedCrossRefGoogle Scholar
  27. 27.
    Agenzia Italiana del Farmaco A (2010) Rapporto gennaio-settembre 2010Google Scholar
  28. 28.
    Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R et al (2009) Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 373:746–758PubMedCrossRefGoogle Scholar
  29. 29.
    Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G et al (2008) Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. J Psychopharmacol (Oxford, England) 22:343–396CrossRefGoogle Scholar
  30. 30.
    Meijer WE, Heerdink ER, Leufkens HG, Herings RM, Egberts AC, Nolen WA (2004) Incidence and determinants of long-term use of antidepressants. Eur J Clin Pharmacol 60:57–61PubMedCrossRefGoogle Scholar
  31. 31.
    Olfson M, Marcus SC, Tedeschi M, Wan GJ (2006) Continuity of antidepressant treatment for adults with depression in the United States. Am J Psychiatry 163:101–108PubMedCrossRefGoogle Scholar
  32. 32.
    Andersson Sundell K, Waern M, Petzold M, Gissler M (2011) Socio-economic determinants of early discontinuation of anti-depressant treatment in young adults. Eur J Public HealthGoogle Scholar
  33. 33.
    Rosholm JU, Andersen M, Gram LF (2001) Are there differences in the use of selective serotonin reuptake inhibitors and tricyclic antidepressants? A prescription database study. Eur J Clin Pharmacol 56:923–929PubMedCrossRefGoogle Scholar
  34. 34.
    Vanelli M, Coca-Perraillon M (2008) Role of patient experience in antidepressant adherence: a retrospective data analysis. Clin Ther 30:1737–1745PubMedCrossRefGoogle Scholar
  35. 35.
    Hansen DG, Vach W, Rosholm JU, Sondergaard J, Gram LF, Kragstrup J (2004) Early discontinuation of antidepressants in general practice: association with patient and prescriber characteristics. Fam Pract 21:623–629PubMedCrossRefGoogle Scholar
  36. 36.
    van Geffen EC, Gardarsdottir H, van Hulten R, van Dijk L, Egberts AC, Heerdink ER (2009) Initiation of antidepressant therapy: do patients follow the GP’s prescription? Br J Gen Pract 59:81–87PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Gianluca Trifirò
    • 1
  • Silvia Tillati
    • 2
  • Edoardo Spina
    • 1
  • Carmen Ferrajolo
    • 3
  • Marianna Alacqua
    • 1
  • Eugenio Aguglia
    • 4
  • Laura Rizzi
    • 2
  • Achille P. Caputi
    • 1
  • Claudio Cricelli
    • 5
  • Fabio Samani
    • 6
  1. 1.Department of Clinical and Experimental Medicine and PharmacologyUniversity of MessinaMessinaItaly
  2. 2.Department of Economic and Statistical SciencesUniversity of UdineUdineItaly
  3. 3.Pharmacovigilance and Pharmacoepidemiology Regional Center, Department of Experimental Medicine, Pharmacology SectionSecond University of NaplesNaplesItaly
  4. 4.Department of Clinical and Molecular BiomedicineUniversity of CataniaCataniaItaly
  5. 5.Italian College of General PractitionersFlorenceItaly
  6. 6.Local Health Unit of TriesteTriesteItaly

Personalised recommendations