Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose

The Dutch guideline for the treatment of depression in young people recommends initiating antidepressant treatment with fluoxetine, as the evidence for its efficacy is strongest and the risk of suicidality may be lower than with other antidepressants. Furthermore, low starting doses are recommended....

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Autores principales: de Vries, Ymkje Anna, de Jonge, Peter, Kalverdijk, Luuk, Bos, Jens H. J., Schuiling-Veninga, Catharina C. M., Hak, Eelko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083767/
https://www.ncbi.nlm.nih.gov/pubmed/26988978
http://dx.doi.org/10.1007/s00787-016-0836-3
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author de Vries, Ymkje Anna
de Jonge, Peter
Kalverdijk, Luuk
Bos, Jens H. J.
Schuiling-Veninga, Catharina C. M.
Hak, Eelko
author_facet de Vries, Ymkje Anna
de Jonge, Peter
Kalverdijk, Luuk
Bos, Jens H. J.
Schuiling-Veninga, Catharina C. M.
Hak, Eelko
author_sort de Vries, Ymkje Anna
collection PubMed
description The Dutch guideline for the treatment of depression in young people recommends initiating antidepressant treatment with fluoxetine, as the evidence for its efficacy is strongest and the risk of suicidality may be lower than with other antidepressants. Furthermore, low starting doses are recommended. We aimed to determine whether antidepressant prescriptions are in accord with guidelines. A cohort of young people aged between 6 and 17 at the time of antidepressant initiation was selected from IABD, a Dutch pharmacy prescription database. The percentage of prescriptions for each antidepressant was determined. Starting and maintenance doses were determined and compared with recommendations for citalopram, fluoxetine, fluvoxamine, and sertraline. During the study period, 2942 patients initiated antidepressant treatment. The proportion of these young people who were prescribed fluoxetine increased from 10.1 % in 1994–2003 to 19.7 % in 2010–2014. However, the most commonly prescribed antidepressants were paroxetine in 1994–2003 and citalopram in 2004–2014. The median starting and maintenance doses were ≤0.5 DDD/day for tricyclic antidepressants and 0.5–1 DDD/day for SSRIs and other antidepressants. Starting doses were guideline-concordant 58 % of the time for children, 31 % for preteens, and 16 % for teens. Sixty percent of teens were prescribed an adult starting dose. In conclusion, guideline adherence was poor. Physicians preferred citalopram over fluoxetine, in contrast to the recommendations. Furthermore, although children were prescribed a low starting dose relatively frequently, teens were often prescribed an adult starting dose. These results suggest that dedicated effort may be necessary to improve guideline adherence. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00787-016-0836-3) contains supplementary material, which is available to authorized users.
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spelling pubmed-50837672016-11-14 Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose de Vries, Ymkje Anna de Jonge, Peter Kalverdijk, Luuk Bos, Jens H. J. Schuiling-Veninga, Catharina C. M. Hak, Eelko Eur Child Adolesc Psychiatry Original Contribution The Dutch guideline for the treatment of depression in young people recommends initiating antidepressant treatment with fluoxetine, as the evidence for its efficacy is strongest and the risk of suicidality may be lower than with other antidepressants. Furthermore, low starting doses are recommended. We aimed to determine whether antidepressant prescriptions are in accord with guidelines. A cohort of young people aged between 6 and 17 at the time of antidepressant initiation was selected from IABD, a Dutch pharmacy prescription database. The percentage of prescriptions for each antidepressant was determined. Starting and maintenance doses were determined and compared with recommendations for citalopram, fluoxetine, fluvoxamine, and sertraline. During the study period, 2942 patients initiated antidepressant treatment. The proportion of these young people who were prescribed fluoxetine increased from 10.1 % in 1994–2003 to 19.7 % in 2010–2014. However, the most commonly prescribed antidepressants were paroxetine in 1994–2003 and citalopram in 2004–2014. The median starting and maintenance doses were ≤0.5 DDD/day for tricyclic antidepressants and 0.5–1 DDD/day for SSRIs and other antidepressants. Starting doses were guideline-concordant 58 % of the time for children, 31 % for preteens, and 16 % for teens. Sixty percent of teens were prescribed an adult starting dose. In conclusion, guideline adherence was poor. Physicians preferred citalopram over fluoxetine, in contrast to the recommendations. Furthermore, although children were prescribed a low starting dose relatively frequently, teens were often prescribed an adult starting dose. These results suggest that dedicated effort may be necessary to improve guideline adherence. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00787-016-0836-3) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2016-03-17 2016 /pmc/articles/PMC5083767/ /pubmed/26988978 http://dx.doi.org/10.1007/s00787-016-0836-3 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Contribution
de Vries, Ymkje Anna
de Jonge, Peter
Kalverdijk, Luuk
Bos, Jens H. J.
Schuiling-Veninga, Catharina C. M.
Hak, Eelko
Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose
title Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose
title_full Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose
title_fullStr Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose
title_full_unstemmed Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose
title_short Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose
title_sort poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the netherlands: choice of antidepressant and dose
topic Original Contribution
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083767/
https://www.ncbi.nlm.nih.gov/pubmed/26988978
http://dx.doi.org/10.1007/s00787-016-0836-3
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