Please use this identifier to cite or link to this item:
Appears in Collections:Faculty of Health Sciences and Sport eTheses
Title: Exploring and Examining Antidepressant Prescribing and Doses used in Primary Care, in Scotland, to Treat Depression
Author(s): Johnson, Christopher F
Supervisor(s): Maxwell, Margaret
Williams, Brian
Dougall, Nadine J
MacGillivray, Stephen A
Keywords: Antidepressant
Selective serotonin reuptake inhibitors
Major depressive disorder
Unipolar depression
General practice
Family medicine
Primary care
Systematic review
General practitioner
Issue Date: Jun-2021
Publisher: University of Stirling
Citation: Johnson CF, Dougall NJ, Williams B, Macgillivray SA, Buchanan AI, Hassett RD. Patient factors associated with SSRI dose for depression treatment in general practice: a primary care cross sectional study. BMC Family Practice. 2014;15:210.
Johnson CF, Williams B, MacGillivray SA, Dougall NJ, Maxwell M. 'Doing the right thing': factors influencing GP prescribing of antidepressants and prescribed doses. BMC Family Practice. 2017;18(1):72.
Abstract: Background: Antidepressant prescribing continues to rise. Selective serotonin reuptake inhibitor (SSRI) use, increased long-term prescribing, and higher doses are contributing to current growth. The majority of antidepressants are prescribed to treat depression. Aim: To explore and examine the use of SSRI doses and dose-response effects for the treatment of depression, for adults, in primary care. Method: An inter-related three study approach was used. A cross-sectional quantitative analysis exploring patient-level factors associated with prescribed daily doses of SSRIs. A qualitative interview study exploring what influences GPs’ use of specific antidepressants and doses. Lastly, a systematic literature review of reviews examining SSRI dose response-effects for efficacy, acceptability and tolerability for acute phase (≤12 weeks) treatment of depression. Results: The quantitative analysis found that higher SSRI doses were significantly associated with, in descending order of magnitude, individual practice attended, being prescribed the same SSRI for ≥2 years and living in a more deprived area. GPs’ treatment of depression involved ethical and professional imperatives of ‘doing the right thing’ for individuals by striving to achieve the ‘right care fit’. Factors influencing prescribing and doses varied over time from first presentation, to initiation and longer-term treatment. Many were unaware that higher SSRI doses lacked greater efficacy, and onset of action occurred within 1-2 weeks; preferring to wait 8-12 weeks before altering treatment. Ongoing pressures to maintain prescribing, few perceived continuation problems and lack of proactive medication review, all combined to further drive prescribing growth over time. Forty-two reviews met inclusion criteria. The majority indicated that SSRIs demonstrated ceiling effects for efficacy; standard doses being non-inferior to higher doses. Higher doses were associated with more adverse events. Conclusion: Although GPs strive ‘to do the right thing’ to help people, better promotion of SSRI dose limitations may help to optimise patient care, reduce prescribing and avoidable ADEs.
Type: Thesis or Dissertation

Files in This Item:
File Description SizeFormat 
Johnson 1929079 PhD Thesis submission 090621 Final 120322.pdfThesis: Exploring and Examining Antidepressant Prescribing and Doses used in Primary Care, in Scotland, to Treat Depression8.11 MBAdobe PDFUnder Embargo until 2023-12-31    Request a copy

Note: If any of the files in this item are currently embargoed, you can request a copy directly from the author by clicking the padlock icon above. However, this facility is dependent on the depositor still being contactable at their original email address.

This item is protected by original copyright

Items in the Repository are protected by copyright, with all rights reserved, unless otherwise indicated.

The metadata of the records in the Repository are available under the CC0 public domain dedication: No Rights Reserved

If you believe that any material held in STORRE infringes copyright, please contact providing details and we will remove the Work from public display in STORRE and investigate your claim.