Supporting depression care: antidepressant prescribing patterns among adults in Alberta, Canada

Depression is a psychiatric disorder associated with emotional, physical and cognitive symptoms that impact an individual’s functioning. Antidepressants play a significant role in treatment because of their demonstrated efficacy. In the Canadian context, there is a paucity of studies that outline long-term trends of antidepressant prescription patterns for patients with depression. Examining prescribing patterns will help us understand current practice in relation to guidelines, and identify areas for enhancing depression care. This study was aimed at understanding whether we had a problem in our jurisdiction with inappropriate anti-depressant prescribing. This descriptive quantitative study analyzed healthcare administrative data to examine antidepressant prescribing patterns in Alberta. The study population comprised adults aged 18 to 65 who received their first depression diagnosis between 2012 and 2022. Key variables were patient demographics; antidepressants prescribed with the cost of the lowest dose; and prescribing physician specialty. To integrate a health equity lens, we merged socio-economic data from Canadian postal code conversion files and the 2021 census with patient data. Our primary focus was identifying the initial pharmacotherapy following a new depression diagnosis. Analysis involved statistical summaries, and trend plots of antidepressants by year, stratified by the other variables. We identified 208,988 Albertans who received a first depression diagnosis and an antidepressant prescription between 2012 and 2022. Escitalopram was the most commonly prescribed antidepressant, especially by family physicians. Other frequently prescribed medications included Lorazepam, Citalopram, Sertraline, Bupropion, and Trazodone. Our findings indicate that the antidepressants chosen as initial pharmacotherapy largely aligned with the Canadian Network for Mood and Anxiety Treatments (CANMAT) Guidelines. An interesting trend was the overall decline in Benzodiazepine Receptor Agonist (BZRA) co-prescribing after 2016, with Lorazepam showing a significant reduction in its once-prominent use. The prescribing patterns did not show inappropriate antidepressant prescribing, rather, the prescribing patterns aligned with recommendations from the CANMAT guidelines. The observed reduction in BZRA use suggests the positive impact of regulatory efforts aimed at curbing inappropriate benzodiazepine prescribing. These findings offer valuable insights into antidepressant prescription characteristics, encompassing demographic, socioeconomic, and geographic trends, as well as patterns in prescribing practices across physician categories.