Real-world effect of antidepressants for depressive disorder in primary care: protocol of a population-based cohort study.

De Crescenzo, Franco; Garriga, Cesar; Tomlinson, Anneka; Coupland, Carol; Efthimiou, Orestis; Fazel, Seena; Hippisley-Cox, Julia; Cipriani, Andrea (2020). Real-world effect of antidepressants for depressive disorder in primary care: protocol of a population-based cohort study. Evidence-Based Mental Health, 23(3), pp. 122-126. BMJ Publishing Group 10.1136/ebmental-2020-300149

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INTRODUCTION

Clinical guidelines recommend antidepressants as the first line of treatment for adults with moderate-to-severe depression. Randomised trials provide the best evidence on the comparative effectiveness of antidepressants for depression, but are limited by a short follow-up and a highly selected population. We aim to conduct a cohort study on a large database to assess acceptability, efficacy, safety and tolerability of antidepressant monotherapy in people with depressive disorder in primary care.

METHODS AND ANALYSIS

This is a protocol for a cohort study using data from the QResearch primary care research database, which is the largest general practice research database in the UK. We will include patients registered for at least 1 year from 1 January 1998, diagnosed with a new episode of depression and on antidepressant and a comparison group not on antidepressant. The exposure of interest will be treatment with antidepressant medications. Our outcomes will be acceptability (treatment discontinuation due to any cause), efficacy (clinical response and remission); safety (adverse events (AEs) and all-cause mortality); and tolerability (dropouts due to any AE) measured at 2 months, 6 months and 1 year. For each outcome, we will estimate the absolute risks for all antidepressants, and relative effects between antidepressants using Cox's proportion hazards models. We will calculate HRs and 99.9% CIs for each outcome of interest.

DISCUSSION

The main limitation is the observational nature of our study, while the major strengths include the large representative population contained in QResearch and the possibly high generalisability.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1362-0347

Publisher:

BMJ Publishing Group

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

26 Jun 2020 14:52

Last Modified:

14 Aug 2020 09:08

Publisher DOI:

10.1136/ebmental-2020-300149

PubMed ID:

32554440

Uncontrolled Keywords:

adult psychiatry depression & mood disorders

BORIS DOI:

10.7892/boris.144791

URI:

https://boris.unibe.ch/id/eprint/144791

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