A Canadian Primary Care Sentinel Surveillance Network Study Evaluating Antidepressant Prescribing in Canada from 2006 to 2012

Objective: To evaluate the prescribing patterns of antidepressants (ADs) by primary care providers to youth, adults, and seniors, from 2006 to 2012, using data from electronic medical records (EMRs). Method: This was a retrospective cross-sectional database study that used primary care data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Data on more than 600 000 Canadian primary care patients were used to determine the prevalence and incidence of AD prescribing to patients 15 years and older who had an encounter in the years of study (from 2006 to 2012). Each study year was evaluated independently. Results: The study population consisted of 86 927 patients in 2006 (mean age 48.1 years [SD 18.7], 38% male) and grew to 273 529 (mean age 49.6 years [SD 19.3], 40% male) in 2012. The prevalence of AD prescribing increased from 9.20% in 2006 to 12.80% in 2012 (P < 0.001). While the incidence rate of AD prescribing dropped from 3.54% in 2006 to 2.72% in 2008 (P < 0.001) the rate started to significantly rise again, reaching an incidence of 3.07% by 2012 (P < 0.001). Conclusions: The prevalence of AD prescribing by primary care providers in Canada continued to rise from 2006 to 2012. Conversely, incidence has remained stable or declined during the 6-year study period. While many complex factors likely contribute to the observed prevalence and incidence rates, our findings suggest that the guidelines indicating the efficacy of long-term AD therapy for patients with highly recurrent or severe depression are being followed.

[1]  R. Stafford,et al.  Off-label prescribing among office-based physicians. , 2006, Archives of internal medicine.

[2]  B. Hankin Journal of Clinical Child & Adolescent Psychology Future Directions in Vulnerability to Depression among Youth: Integrating Risk Factors and Processes across Multiple Levels of Analysis , 2022 .

[3]  G. Trifirò,et al.  Antidepressant drugs: prevalence, incidence and indication of use in general practice of Southern Italy during the years 2003–2004 , 2007, Pharmacoepidemiology and drug safety.

[4]  H. Baumeister Inappropriate prescriptions of antidepressant drugs in patients with subthreshold to mild depression: time for the evidence to become practice. , 2012, Journal of affective disorders.

[5]  Jian Li Wang,et al.  Descriptive Epidemiology of Major Depression in Canada , 2006, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[6]  Chronic conditions more than age drive health system use in Canadian seniors. , 2011, Healthcare quarterly.

[7]  S. Patten,et al.  Reasons for antidepressant prescriptions in Canada , 2007, Pharmacoepidemiology and drug safety.

[8]  E. Isometsä,et al.  Antidepressant treatment of depression in the Finnish general population. , 2001, The American journal of psychiatry.

[9]  R. Kessler,et al.  Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. , 2004, JAMA.

[10]  B. Psaty,et al.  Estimating ethnic differences in self‐reported new use of antidepressant medications: results from the Multi‐Ethnic Study of Atherosclerosis , 2009, Pharmacoepidemiology and drug safety.

[11]  G. Canino,et al.  Psychopathology associated with suicidal ideation and attempts among children and adolescents. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[12]  D. Tedstone Doherty,et al.  Gender and self-reported mental health problems: predictors of help seeking from a general practitioner. , 2010, British journal of health psychology.

[13]  S. Patten,et al.  Major Depression and Mental Health Care Utilization in Canada: 1994 to 2000 , 2004, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[14]  S. Morgan,et al.  Antidepressant utilization in British Columbia from 1996 to 2004: increasing prevalence but not incidence. , 2007, Psychiatric services.

[15]  P. Mitchell,et al.  Recent trends in the use of antidepressant drugs in Australia, 1990–1998 , 2000, The Medical journal of Australia.

[16]  David L Buckeridge,et al.  Drug, patient, and physician characteristics associated with off-label prescribing in primary care. , 2012, Archives of internal medicine.

[17]  S. Patten,et al.  Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. Introduction. , 2009, Journal of affective disorders.

[18]  R. Kessler,et al.  Medication management of depression in the United States and Ontario , 1998, Journal of General Internal Medicine.

[19]  P. Cuijpers,et al.  Preventing depression: a global priority. , 2012, JAMA.

[20]  T. B. Üstün,et al.  Global burden of depressive disorders in the year 2000 , 2004, British Journal of Psychiatry.

[21]  C. Sherbourne,et al.  The quality of care for depressive and anxiety disorders in the United States. , 2001, Archives of general psychiatry.

[22]  S. Currie,et al.  Chronic conditions and major depression in community-dwelling older adults. , 2011, Journal of affective disorders.

[23]  Mark Olfson,et al.  Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. , 2011, Health affairs.

[24]  R. Dahl,et al.  Psychosocial functioning in youths at high risk to develop major depressive disorder. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[25]  M. Lai,et al.  Utilization of antidepressants in Taiwan: a nationwide population‐based survey from 2000 to 2009 , 2012, Pharmacoepidemiology and drug safety.

[26]  P. Lewinsohn,et al.  Natural course of adolescent major depressive disorder: I. Continuity into young adulthood. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[27]  J. Sareen,et al.  Effect of regulatory warnings on antidepressant prescription rates, use of health services and outcomes among children, adolescents and young adults , 2008, Canadian Medical Association Journal.

[28]  Jian Li Wang,et al.  Antidepressant utilization in Canada , 2005, Social Psychiatry and Psychiatric Epidemiology.

[29]  M. Olfson,et al.  National patterns in antidepressant medication treatment. , 2009, Archives of general psychiatry.