Using the CRIS database to investigate sex differences in antidepressant prescribing in secondary care

Hasnain Mussadiq Lalji, Anita McGrogan, Sarah Bailey

Research output: Contribution to journalMeeting abstractpeer-review

Abstract

Sex differences are evident in the prevalence, symptom presentation and treatment response of psychiatric disorders (Bolea-Alamanac et al., 2018). Antidepressant treatments show sex differences in their efficacy, side effect profile and pharmacokinetics. For example, young women, but not men, show a greater response to selective serotonin reuptake inhibitors (SSRIs) than tricyclic antidepressants (Damoiseaux et al., 2014). Here, we aim to use the Clinical Record Interactive Search (CRIS) database to assess antidepressant prescribing practice and effectiveness.
Local governance and ethics approval were obtained. The CRIS database allows retrieval of de-identified patient case note information. Adult patients (18-65 years), with a referral during 2017, with a primary diagnosis of major depressive disorder single (ICD10 code: F32.0, 32.1, 32.2, 32.3, 32.4, 32.5, 32.9) or recurrent (ICD10 code: F33.0, 33.1, 33.2, 33.3, 33.4, 33.9) episodes were included in the search. Antidepressant use was determined using an algorithm developed in General Architecture for Text Engineering (GATE) software designed to extract data on any medication recorded in the case notes.
Initially, data from 796 patients was refined to exclude patients with any physical health condition, co-morbid psychiatric conditions and depression with symptoms of psychosis. A cohort of 234 patients was obtained (122 women; 112 men) with little difference in mean age (51.3 years women;49.5 years men). At the start of the observation period, of the women prescribed a single antidepressant, 22% were on sertraline (vs 18% of men), 20% citalopram (vs 19%) and 18% fluoxetine (vs 8%). Slightly more men than women were on mirtazapine (22% vs 14%) and venlafaxine (18% vs 12%). This may be related to differences in diagnoses as more women than men were diagnosed with recurrent depressive episode (42% vs 29%) while more men than women were diagnosed with moderate depression (31% vs 21%). While the diagnosis remained unchanged in the observation period, the pattern of antidepressant prescribing changed.
This study demonstrates the utility of the CRIS database for investigating sex differences in antidepressant prescribing. However, the complexity of diagnoses (which may be revealed only in case notes) and around quarter of patients being prescribed more than one antidepressant makes it difficult to draw conclusions about the drivers for prescribing choice and whether sex of patients and treatment choice are related.

ACKNOWLEDGEMENTS: Access to the CRIS database was facilitated by Lara Skinner and Julian Walker at the Avon and Wiltshire Mental Health Partnership NHS Trust.

References
Bolea-Alamanac B, Bailey SJ, Lovick TA, Scheele D, & Valentino R (2018). Female psychopharmacology matters! Towards a sex-specific psychopharmacology. Journal of Psychopharmacology 32: 125-133.

Damoiseaux VA, Proost JH, Jiawan VCR, & Melgert BN (2014). Sex Differences in the Pharmacokinetics of Antidepressants: Influence of Female Sex Hormones and Oral Contraceptives. Clinical pharmacokinetics 53: 509-519.
Original languageEnglish
Pages (from-to)A108-A109
Number of pages2
JournalJournal of Psychopharmacology
Volume36
Issue number8
Publication statusAcceptance date - 25 May 2022

Bibliographical note

Abstract presented at BAP Summer Meeting, July 2022

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