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Ambresin et al, 2015 What factors influence long-term antidepressant use in primary care? Findings from the Australian diamond...


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Journal of Affective Disorders , Volume 176 , 125 - 132

What factors influence long-term antidepressant use in primary care? Findings from the Australian diamond cohort study

Gilles Ambresinab, Victoria Palmera, Konstancja Densleya, Christopher Dowrickc, Gail Gilchristd, Jane M Gunna

 

Abstract at http://www.jad-journal.com/article/S0165-0327%2815%2900068-3/abstract

 

Background
 
Antidepressants are one of the most commonly prescribed drugs in primary care. The rise in use is mostly due to an increasing number of long-term users of antidepressants (LTU AD). Little is known about the factors driving increased long-term use. We examined the socio-demographic, clinical factors and health service use characteristics associated with LTU AD to extend our understanding of the factors that may be driving the increase in antidepressant use.
 
Methods
Cross-sectional analysis of 789 participants with probable depression (CES-D≥16) recruited from 30 randomly selected Australian general practices to take part in a ten-year cohort study about depression were surveyed about their antidepressant use.
 
Results
165 (21.0%) participants reported <2 years of antidepressant use and 145 (18.4%) reported ≥2 years of antidepressant use. After adjusting for depression severity, LTU AD was associated with: single (OR 1.56, 95%CI 1.05–2.32) or recurrent episode of depression (3.44, 2.06–5.74); using SSRIs (3.85, 2.03–7.33), sedatives (2.04, 1.29–3.22), or antipsychotics (4.51, 1.67–12.17); functional limitations due to long-term illness (2.81, 1.55–5.08), poor/fair self-rated health (1.57, 1.14–2.15), inability to work (2.49, 1.37–4.53), benefits as main source of income (2.15, 1.33–3.49), GP visits longer than 20 min (1.79, 1.17–2.73); rating GP visits as moderately to extremely helpful (2.71, 1.79–4.11), and more self-help practices (1.16, 1.09–1.23).
 
Limitations
All measures were self-report. Sample may not be representative of culturally different or adolescent populations. Cross-sectional design raises possibility of “confounding by indication”.
 
Conclusions
Long-term antidepressant use is relatively common in primary care. It occurs within the context of complex mental, physical and social morbidities. Whilst most long-term use is associated with a history of recurrent depression there remains a significant opportunity for treatment re-evaluation and timely discontinuation.

 
Link to full text - http://www.sciencedirect.com.ezproxy.lib.rmit.edu.au/science/article/pii/S0165032715000683# (subscription required)

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Please note - I am not a medical practitioner and I do not give medical advice. I offer an opinion based on my own experiences, reading and discussion with others.On Effexor for 2 months at the start of 2005. Had extreme insomnia as an adverse reaction. Changed to mirtazapine. Have been trying to get off since mid 2008 with numerous failures including CTs and slow (but not slow enough tapers)Have slow tapered at 10 per cent or less for years. I have liquid mirtazapine made at a compounding chemist.

Was on 1.6 ml as at 19 March 2014.

Dropped to 1.5 ml 7 June 2014. Dropped to 1.4 in about September.

Dropped to 1.3 on 20 December 2014. Dropped to 1.2 in mid Jan 2015.

Dropped to 1 ml in late Feb 2015. I think my old medication had run out of puff so I tried 1ml when I got the new stuff and it seems to be going ok. Sleep has been good over the last week (as of 13/3/15).

Dropped to 1/2 ml 14/11/15 Fatigue still there as are memory and cognition problems. Sleep is patchy but liveable compared to what it has been in the past.

 

DRUG FREE - as at 1st May 2017

 

>My intro post is here - http://survivingantidepressants.org/index.php?/topic/2250-dalsaan

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