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Objective: Non-response to antidepressant treatment is a substantial problem in Primary Care, and many patients with depression require additional second-line treatments. This study aimed to examine the prevalence and patterns of antidepressant switching in the UK, and identify associated demographic and clinical factors.

Method: Cohort analysis of antidepressant prescribing data from the Clinical Practice Research Datalink; a large, anonymised, UK primary care database. The sample included 262,844 patients who initiated antidepressant therapy between 1st January 2005 and 31st June 2011.
Results: 9.3% of patients switched to a different antidepressant product, with most switches (60%) occurring within eight weeks of the index date. The proportion switching was similar for SSRIs, TCAs and other antidepressants (9.3%, 9.8% and 9.2% respectively). Most switches were to an SSRI (64.5%), and this was the preferred option regardless of initial antidepressant class. Factors predictive of switching included male gender, younger (<18 years) and older age (>60 years), and history of self-harm and psychiatric illness.

Over one in every eleven patients who initiates antidepressant therapy will switch medication, suggesting that initial antidepressant treatment has been unsatisfactory. Evidence to guide choice of second-line treatment for individual patients is currently limited. Additional research comparing different pharmacological and psychological second-line treatment strategies is required In order to inform guidelines, and improve patient outcomes.
Original languageEnglish
Article number31
Pages (from-to)553-560
Number of pages8
JournalJournal of Psychopharmacology
Issue number5
Early online date1 Feb 2017
Publication statusPublished - May 2017

Structured keywords

  • SASH


  • CPRD
  • Antidepressants
  • General practice
  • Switching
  • Primary care
  • Depression


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