Antidepressant exposure, response and resistance in Severe Mental Illness – patterns and consequences
Project reference: RAS-24-2
Approval date: 29 May 2024
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Lead organisation |
Principal Investigator |
|---|---|
| University of Edinburgh | Matthew Iveson |
Plain English summary
This project aims to examine the pattern of antidepressant use within patients living with Severe Mental Illness, identifying changes in treatment that are indicative of response, non-response and resistance (e.g., frequent switching to different antidepressants). It also aims to examine the consequences of these changes in terms of the healthcare utilisation and mortality risk of individuals living with Severe Mental Illness. This will result in academic papers and lay reports, tools that add value to national prescribing data for other researchers, and a stakeholder workshop to co-design meaningful changes to prescribing policy.
Statement of public good
Understanding the patterns and consequences of antidepressant use can improve the lives of those living with Severe Mental Illness (SMI) by helping them to find effective treatments quickly. Findings will help inform clinical decision making in these complex cases and minimize treatment burden on those living with SMI. Furthermore, we will produce tools that add value to national prescribing data, making it easier to examine treatment response and to track medication use in future research. We will run a stakeholder workshop, bringing together patients living with mental illness, medical professionals and healthcare policy makers to highlight medication-related challenges faced by patients and to co-design meaningful changes to policy.
Datasets used
- Scottish Morbidity Records (SMR) 00 - Outpatient Appointments and Attendances
- Scottish Morbidity Records (SMR) 01 - General Acute Inpatient and Day Case
- Scottish Morbidity Records (SMR) 04 - Mental Health Inpatient and Day Case
- Prescribing Information System (PIS)
- Scotland Accident and Emergency (A&E)
- National Records of Scotland (NRS) - Deaths Data
What the project achieved
Project findings
The project demonstrated that antidepressant use among those living with SMI was fundamentally different to a matched group of controls with no SMI. Researchers also identified common patterns of antidepressant use among those with SMI. These patterns were differentially associated with hospitalisation risk and mortality risk, and associations were stronger in those living with SMI than those without SMI.
Individuals with substantial missingness in prescribing patterns were at the highest risk of hospitalisation, and this association was stronger in those with SMI. Given that prescribing data was limited to community dispensing, this missingness likely represents treatment that occurs within secondary care settings. Future studies should seek to fill this gap to more accurately to reflect real-world treatment and to better assess the association between SMI and morbidity/mortality risks.
How was the public involved?
The initial project plan was presented and discussed with the Lived Experience Advisory Panel of the Wellcome-funded AMBER project. They helped to shape the research questions. Findings have since been presented to them, particularly for interpreting the clusters of antidepressant patterns identified during analysis.
How does the public benefit from the project's findings?
The project highlights antidepressant prescribing patterns most associated with health risks. Researchers are currently validating these findings in other cohorts and will produce accessible reports to inform health policy makers and prescribers.
The results also highlight the importance of research access to hospital-based prescribing records, and adds to conversations about the development of the health data landscape for patient good.