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What proportion of initially prescribed antidepressants is still being prescribed chronically after 5 years in general practice? A longitudinal cohort analysis
  1. Peter F M Verhaak1,2,
  2. Derek de Beurs1,
  3. Peter Spreeuwenberg1
  1. 1 Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
  2. 2 Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Peter F M Verhaak; p.verhaak{at}


Objectives Antidepressant prescribing almost doubled in the Netherlands between 1996 and 2012, which could be accounted for by longer continuation after the first prescription. This might be problematic given a growing concern of large-scale antidepressant dependence. We aimed to assess the extent and determinants of chronic antidepressant prescribing among patient aged 18 years and older. We hypothesise a relatively large prevalence of chronic (>2 years) prescription.

Design A longitudinal observational study based on routinely registered prescription data from general practice.

Setting 189 general practices in the Netherlands.

Participants 326 025 patients with valid prescription data for all 5 years of the study.

Outcome measures Primary outcome measure: the number of patients (N) receiving at least four antidepressant prescriptions in 2011, as well as during each of the four subsequent years. Secondary outcome measure: the above, but specified for selective serotonin reuptake inhibitors and for tricyclic antidepressants.

Results Antidepressants were prescribed to almost 7% of our 326 025 participants each year. They were prescribed for depression (38%), anxiety (17%), other psychological disorders (20%) and non-psychological indications (25%). Antidepressants were prescribed in all 5 years to the 42% of the population who had at least four prescriptions dispensed in 2011. Chronic prescribing was higher among women than men, for those aged 45–64 years than for those aged >65 years and for those treated for depression or anxiety than for non-psychological indications (eg, neuropathic pain). Chronic prescribing also varied markedly among general practices.

Conclusion Chronic antidepressant use is common for depression and for anxiety and non-psychological diagnoses. Once antidepressants have been prescribed, general practitioners and other prescribers should be aware of the risks associated with long-term use and should provide annual monitoring of the continued need for therapy.

  • primary care
  • anxiety disorders

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  • Patient consent for publication Not required.

  • Contributors PFMV conceived the concept, analysed the data and wrote the paper. DdB discussed the concept and commented on all drafts. PS performed the multilevel analysis and commented on all drafts.

  • Funding All authors are appointed by the Netherlands Institute of Health Services Research and had access to NIVEL Primary Care Database.

  • Competing interests None declared.

  • Ethics approval This study has been approved according to the governance code of Nivel Primary Care Database, under number NZR-00318.012. European law allows the use of electronic health records for research purposes under certain conditions. According to this legislation, neither obtaining informed consent from patients nor approval by a medical ethics committee is obligatory for this type of observational studies containing no directly identifiable data. This study was conducted in accordance with the requirements of the Helsinki Declaration. Patients in participating practices are informed about participation of the practice in NPCD with an opportunity for opting out.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We have got access to the anonymous database under condition that data will be used only for the answering of the current research questions. Researcher interested in our analyses can contact the first author or Dr Derek de Beurs (second author) at NIVEL for possible secondary analysis of our data set.