Potential deprescribing indications for antidepressants between 2012 and 2019: repeated cross-sectional analysis in two Scottish health boards
Authors: Brisnik Vita , Rottenkolber Marietta , Vukas Jochen , Schechner Miriam , Lukaschek Karoline , Jung-Sievers Caroline , Gensichen Jochen , Thiem Ulrich , Drey Michael , Krüger Nils , Mair Alpana , Guthrie Bruce , Fischer Sebastian , Dreischulte Tobias ,   for the POKAL Study Group, Falkai Peter , Henningsen Peter , Bühner Markus , Krcmar Helmut , Pitschel-Walz Gabriele , Schneider Antonius , Lochbuhler Kirsten , Prommegger Barbara , Schmitt Andrea , Biersack Katharina , Brand Constantin , Ebert Christopher , Eder Julia , Gökce Feyza , Haas Carolin , Pfeiffer Lisa , Kaupe Lukas , Raub Jonas , Reindl-Spanner Philipp , Schillok Hannah , Schönweger Petra , Teusen Clara , Vogel Marie , von Schrottenberg Victoria , Younesi Puya 
Published: September 2024

Abstract
Background
Antidepressants have a pivotal role in the treatment of many psychiatric disorders, but there are concerns about long-term use and adverse effects. The objectives of this study were (1) to examine time trends in antidepressant use, (2) to estimate the prevalence of long-term and potential high-risk antidepressant use, and (3) to examine patient characteristics associated with potential deprescribing indications (PDIs) (i.e., simultaneous long-term and potential high-risk antidepressant use).

Methods
Repeated population-based cross-sectional study for all 609,299 people aged ≥ 18 years resident in the Tayside or Fife regions of Scotland. The prevalence of antidepressant use was examined on June 30th (index date) of each year from 2012 to 2019, while the prevalence of long-term and potential high-risk use as well as PDIs was assessed and compared on the same dates in 2012 and 2019. Binary logistic regression modeling was used to examine patient characteristics associated with PDIs.

Results
Antidepressant use increased by 27% from 12.0 to 15.3% among adult residents between 2012 and 2019. While the proportion of antidepressants users dispensed ≥ 1 antidepressant for > 2 years increased from 54.3 to 61.9% between 2012 and 2019, the proportion of antidepressant users triggering ≥ 1 indicator of potential high-risk use decreased slightly from 37.9 to 34.7%. In 2019, potential high-risk use most commonly related to indicators targeting fall risk (16.0%), cardiovascular risks (14.1%), insomnia (10.6%), and risk of orthostatic hypotension (8.6%). More than 1 in 4 (25.8%) antidepressant users had PDIs. The main risk factors associated with PDIs included increasing age (65–79, adjusted OR 14.12; 95% CI, 13.15–15.17), increasing number of drugs taken concomitantly (≥ 15 drugs, adjusted OR 7.37; 95% CI, 6.71–8.10), use of tricyclic antidepressants (≥ 50 mg) (adjusted OR 5.49; 95% CI, 5.02–6.01), and concomitant use of ≥ 2 antidepressants (adjusted OR 5.52; 95% CI, 5.20–5.85).

Conclusions
Long-term and potential high-risk use of antidepressants is widespread, and potential deprescribing indications (PDIs) are increasing, suggesting the need for a critical review of their ongoing use by clinicians. If deemed necessary, future deprescribing interventions may use the criteria applied here for identification of patients with PDIs and for evaluating intervention effectiveness.