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Q What is the frequency and pattern of antidepressant use in Canadian people with major depression?
Prospective longitudinal study.
General population, Canada; enrolment 1994–95.
9438 people aged over 15 years at enrolment, randomly sampled from the general population. Exclusions: military bases, native reserves, and some remote areas.
Data were collected every two years on the frequency of healthcare use in relation to major depression as part of the National Population Health Survey. Episodes of depression in the year preceding assessment were identified using the Composite International Diagnostic Interview Short Form for Major Depression. Any medications used in the two days preceding the interview were recorded and participants were asked if they had consulted a health professional about their mental health and about the frequency of these consultations.
Follow up period:
The prevalence of major depression did not significantly change during follow up (1994–95 v 2000–01: 6% v 5%). Among people with major depression, antidepressant use has significantly increased over time (see table). The greatest increases in antidepressant use were in people <35 years, unmarried people, and men. Antidepressant use also increased across educational groups, and in both urban and rural areas (data not shown). There was a significant increase in the use of concomitant medications. The frequency of visits to alternative practitioners also significantly increased (1994–95: 3%, 95% CI 2 to 5; 2000–01: 12%, 95% CI 8 to 16).
Antidepressant use is increasing in people with major depression in Canada, particularly in men, unmarried people, and people aged less than 35 years. This appears to be due to changes in practice as the frequency of professional consultation has not increased.
This paper addresses the undertreatment of depression, an important and continuing public health problem. Depression is prevalent, particularly among women, and functional consequences of untreated major or subsyndromal depression are significant.1 It is in this context that Patten and Beck’s work gives cause for optimism, suggesting that practice patterns related to the identification and treatment of major depression are improving, and important disparities in treatment disappearing. These findings are particularly noteworthy because the authors found no corresponding increase in mental-health-specific consultations. Clinicians simply appear to be doing a better job of identifying and treating major depression in routine practice. Other findings indicate improved care: Patten and Beck found significant progress among groups of people that, in previous surveys, had lower treatment rates. In the past, men with episodes of major depression were less likely to take antidepressants than women, but this difference nearly disappeared in the period between 1994/1995 and 2000/2001. Similarly, rates of antidepressant use among individuals in certain sociodemographic categories have also improved: differences in antidepressant use have disappeared or nearly disappeared among people with lower education levels compared with people possessing higher education levels, among unmarried people compared with married people, and among individuals aged 15–34 years compared with those aged 35–54 years. At the same time, significant opportunities for improvement exist. People with past-year major depression living in rural areas remain less likely to take antidepressants than those living in urban areas, and given reduced disparities in other categories, improving treatment for rural residents may present an important challenge. Most importantly, many people with depression, irrespective of sociodemographic profile, do not receive treatment despite common opportunities for screening in healthcare settings. Clinicians should consider more frequent screening for depression2 and collaborative care models, such as those developed by Katon et al,3 that increase uptake and proper use of prescribed antidepressants.
There are two authors of the featured article (C A Green. Canadian study finds that antidepressant use has increased in people with major depression over the past decade). The second author, whose name should also appear on the article but has been omitted, is: C Beck.
For correspondence: Dr S Patten, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada;
Sources of funding: Institute of Health and Economics, Canada.
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