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Title: Epidemiology of antidepressant drug prescribing to young people
Author: Murray, Macey Lee
ISNI:       0000 0004 2681 546X
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2009
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Until recently, the use of antidepressant (ATD) drugs by young people for the treatment of psychiatric and behavioural disorders had increased in Europe and the United States. However in 2003, regulatory agencies worldwide restricted the use of the selective serotonin reuptake inhibitors (SSRIs) and other newer ATDs by children and adolescents due to their association with an increased risk of suicidal ideation and behaviour. The extent of use of these drugs by young people in UK general practice both before and after the restrictions was unknown. It was unclear when young people discontinued treatment for depression and whether this depended on the class of ATD prescribed. The impact of the restrictions on the clinical practices of specialist clinicians was also unknown. This thesis aimed to: 1) evaluate literature data on suicidality risk and newer ATDs; 2) investigate psychotropic drug prescribing trends, focusing on ATD use in general practice before and after the regulatory changes, and investigate treatment cessation for depression; 3) assess specialists' practices and opinions on the regulatory changes. Systematic literature review, pharmacoepidemiological techniques using large clinical databases (IMS Prescribing Insights, the General Practice Research Database, and IMS Disease Analyzer-Mediplus), and survey methods were employed. Global use of psychotropic drugs by young people increased between 2000 and 2002; prescription volume rose by 68% in the UK. Between 1992 and 2001, ATD prescribing to children and adolescents (≤18 years) increased by 70%, with SSRIs gaining popularity compared with tricyclic ATDs. However, between 2002 and 2004, the use of the restricted drugs declined by a third. More than half of depressed patients treated with ATDs discontinue or switch treatment within two months. In response to the regulatory changes specialist clinicians have restricted their use of ATDs despite some disagreeing with them. Resources for psychological therapies such as cognitive-behavioural therapy are limited.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available