Temporal trends of antidepressant utilization patterns in children and adolescents in Hong Kong: A 14-year population-based study with joinpoint regression analysis

Abstract

<h3>Background</h3><p>There is limited research on real-world antidepressant utilization patterns in children and adolescents, particularly in non-western countries. We aimed to examine temporal trends of antidepressant prescribing practice among Chinese children and adolescents in Hong Kong over 14-year period.</p><h3>Methods</h3><p>This population-based study identified 9566 patients aged 5–17 years who had redeemed at least one antidepressant prescription within 2005–2018, using data from health-record database of Hong Kong public healthcare services. We calculated annual prescription rates (per 1000 persons) for any antidepressant, antidepressant <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/chemotherapeutic-agent" title="Learn more about drug from ScienceDirect's AI-generated Topic Pages">drug</a> classes, and individual antidepressants. Joinpoint-regression analyses were performed to assess temporal antidepressant prescription trends, quantified by average annual-percent-change (AAPC), with 95 % confidence-intervals (CIs).</p><h3>Results</h3><p>Overall antidepressant prescription rate significantly increased over time (AAPC: 7.30 [95 % CI: 6.70–7.90]), from 3.883 in 2005 to 9.916 in 2018. The use of selective-serotonin-reuptake-inhibitors (SSRIs), serotonin-norepinephrine-reuptake-inhibitors (SNRIs), and other antidepressants significantly increased over 14 years, while tricyclic-antidepressants remained stable. SSRI represented the most commonly-prescribed <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/chemotherapeutic-agent" title="Learn more about drug from ScienceDirect's AI-generated Topic Pages">drug</a> class. <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/fluoxetine" title="Learn more about Fluoxetine from ScienceDirect's AI-generated Topic Pages">Fluoxetine</a> and <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/sertraline" title="Learn more about sertraline from ScienceDirect's AI-generated Topic Pages">sertraline</a> constituted the two most frequently-prescribed individual antidepressants, while <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/desvenlafaxine" title="Learn more about desvenlafaxine from ScienceDirect's AI-generated Topic Pages">desvenlafaxine</a> (AAPC: 55.68 [30.74–85.39]) and <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/bupropion" title="Learn more about bupropion from ScienceDirect's AI-generated Topic Pages">bupropion</a> (AAPC: 35.28 [23.68–47.98]) exhibited the sharpest increase in prescription rates over the study period.</p><h3>Limitations</h3><p>Medication adherence could not be assessed and actual drug use may be overestimated.</p><h3>Conclusions</h3><p>Our results affirm a significant rising trend of antidepressant prescriptions among Chinese children and adolescents over time. All antidepressant drug-classes, except TCA, demonstrated significantly increased use, with SSRI being the most frequently-prescribed drug class. Future investigation should clarify indications, hence off-label use, of antidepressant initiation in this vulnerable population.</p>