Rates of antidepressant medication dispensing are on the rise among young people, according to a new study published in the New Zealand Medical Journal today. What can this tell us about our prescribing habits and the demographics missing out?
According to an article in the New Zealand Medical Journal, the rates of antidepressant dispensing (the people filling their prescriptions) among young people are at an all-time high.
The journal article, IDI trends in antidepressant dispensing to New Zealand children and young people between 2007/08 and 2015/16, says in the nine-year study period, the total rate of dispensing for people aged one to 24 rose by 44%.
The study didn’t look at the diagnoses leading to antidepressant prescriptions, but co-author and associate professor of youth mental health at the University of Auckland, Sarah Hetrick, says the increase in rates of dispensing was not necessarily a sign that rates of depression and anxiety disorders were increasing.
What the findings do say, she explains, is that the types of medication being dispensed are more aligned with recommended guidelines.
“We have increases in fluoxetine and that is the first line guideline-recommended antidepressant, which is what you would prescribe for someone with depression. We have decreases in the use of tricyclic antidepressants, or TCA, and that’s because the guidelines say you shouldn’t use those and that’s because they don’t work that well in young people.”
It’s a positive trend and shows that those prescribing the drugs are listening to the clinical recommendations, Hetrick says.
“Patterns that we’re seeing in terms of the different medications are consistent with those guidelines of what should be happening, so that’s another clue that this [dispensing increase] is not necessarily a bad thing.”
The group where antidepressant dispensing increased the most was for those between the ages of 13 and 17, rising by 83% in the nine-year study period. Women between 18 and 24 were also the most likely to have accessed antidepressants in the study period at a rate of almost one in ten.
The increases might seem like a lot but Hetrick says they’re consistent with worldwide trends.
“If you look at other studies that involve prescribing or dispensing they all show an increase. There’s a range of rates of increase and we’re at the upper end in New Zealand but consistent with other studies.”
Women, New Zealand Europeans and those of lower socioeconomic status were all more likely to have received antidepressants during the study period. The data was also divided into five groups by socio-economic status. Interestingly, those in the most deprived quintile had the lowest dispensing rates of all four more privileged groups.
The study says there could be a range of factors for this, and it’s likely that “factors including the cost of medication, health literacy, medical practitioners bringing a scientific view only to consultations (ie, lacking cultural awareness and understanding), and culturally mediated beliefs about treatments are responsible for these differences.”
Hetrick says the study didn’t explore why this disparity exists but agrees it’s likely down to a number of things.
“We can guess that people with lower socio-economic opportunity can’t afford the medication or can’t afford to go to the doctor or can’t access healthcare in the way that those of us who are privileged can… [people] in the higher rates of socio-economics have the privilege of services that are designed to suit them and they work in a way that suits them. It requires driving there, there’s no such thing as home visiting for people who don’t have cars or can’t get transport, most of our services are in places where most people live so if you go out of our major cities what services are available? I think it speaks to those kinds of disparities.”
Cultural barriers can also change how medical care is given and received, further contributing to the disparity. Hetrick wants people, especially those in charge of giving out prescriptions for these antidepressant drugs, to read the study, and hopes it serves as a reminder of what the guidelines say about prescribing and dispensing these treatments.
“We make a really important point that we can see some obvious disparity in prescribing, so again I think the clinical implication is a reminder to prescribers to make sure that their practices culturally are responsive, and I mean that in terms of youth culture as well as ethnicity… that their practice is such that we don’t see disparity in regards to quality of care.”
“Prescription of an antidepressant can be a really important part of the treatment. We wouldn’t want to miss that and certainly not in groups where we are seeing disparity at the moment.”
The study concludes: “despite our inability to determine the clinical rationale for increased dispensing of antidepressants, the available data highlight some potentially significant improvements as well as disparities in healthcare.”
It’s only one of a number of different studies that could be done to show how, why and when young people are accessing antidepressants, says Hetrick, but the study does indicate some changes that could benefit youth mental health in New Zealand.
“I think the clinical implications for me are about quality improvement, a reminder about how we should be prescribing and working.”
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